{ "hospital_name": "Knapp Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Knapp Medical Center" ], "hospital_address": [ "1401 East Eighth Street Weslaco, TX 78596" ], "license_information": { "license_number": "741393060", "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": "Rene Lopez" }, "type_2_npi": [ "1861488579" ], "standard_charge_information": [ { "description": " - S2900 - ", "code_information": [ { "code": "S2900", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9563.81, "minimum": 550.8755, "maximum": 9372.5338, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1264.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1199.95 }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1405.35 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1405.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "standard_charge_algorithm": "Not To Exceed $6000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1292.75, "10th_percentile": 1292.75, "90th_percentile": 1292.75, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1118.76, "10th_percentile": 1118.76, "90th_percentile": 1118.76, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11313, "minimum": 7919.366, "maximum": 19798.415, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10973.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19798.42, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9468.03 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8068.39 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10337.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11313.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10337.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10647.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10337.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11313.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7919.37, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11313.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11087.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14707.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14707.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10957.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13438.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17535.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10854.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10854.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16023.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 18101.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 18090.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11313.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11313.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9050.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9050.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10854.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9899.21, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14707.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10337.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10337.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18667.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10182.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10182.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11313.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8067.06 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11313.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10337.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10337.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11313.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8485.04, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9932, "minimum": 4335, "maximum": 17381.385, "payers_information": [ { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9932.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7449.17, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9634.25, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17381.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11091.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9452.03 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9113.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9932.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9113.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9386.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9113.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9932.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6952.55, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9932.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9733.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12911.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12911.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9660.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11847.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15394.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9569.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9569.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14125.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15891.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15948.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9932.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9932.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7945.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7945.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9569.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8690.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12911.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9113.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9113.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16388.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8939, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8939, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4335 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9932.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9113.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9113.37, "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": 10949, "minimum": 706, "maximum": 19161.975, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10621.21, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19161.98, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "per diem", "standard_charge_dollar": 938 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "per diem", "standard_charge_dollar": 706 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10949.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10315.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10949.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7664.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10949.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10730.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14234.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14234.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10616.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13019.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16972.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10515.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10515.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15523.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 17519.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 17526.43, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10949.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10949.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8759.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8759.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10515.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9580.99, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14234.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18067.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9854.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9854.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10949.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6208.12 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10949.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10949.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8212.28, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25890, "minimum": 18123.644, "maximum": 45309.11, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25114.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 45309.11, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28582.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 24356.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 23256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 25890.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 23954.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 23256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 25890.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18123.64, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25890.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 25373.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 33658.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 33658.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24652.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 30233.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 40130.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24419.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 24419.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36048.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 41425.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 40699.58, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 25890.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25890.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 20712.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20712.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 24419.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 22654.56, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 33658.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 23256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 42720.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 23301.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 23301.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25890.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28257.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 25890.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 23256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 25890.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 19418.19, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10688, "minimum": 7482.083, "maximum": 18705.2075, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10368.03, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18705.21, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10912.6 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9299.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9783.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10688.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9783.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10077.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9783.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10688.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7482.08, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10688.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10474.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13895.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13895.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10370.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12718.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16567.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10273, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10273, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15164.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 17101.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 17121.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10688.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10688.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8550.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8550.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10273, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9352.6, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13895.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9783.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9783.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17636.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9619.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9619.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10688.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10270 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10688.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9783.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9783.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10688.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8016.52, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17339, "minimum": 7277.92, "maximum": 30344.1425, "payers_information": [ { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17339.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13871.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13871.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 16462.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 15172.07, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 22541.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15678.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15678.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 28610.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15605.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15605.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17339.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7277.92 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17339.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15678.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15678.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17339.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 13004.63, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16819.32, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 30344.14, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17511.76 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14923.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15678.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 17339.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15678.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16148.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15678.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17339.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12137.66, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17339.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16992.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22541.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 22541.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16618.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 20381.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26876.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16462.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16462.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24301.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 27743.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 27436.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 17339.51, "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": 9457, "minimum": 2925.92, "maximum": 16550.24, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9173.56, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16550.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6863.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5848.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8692.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8692.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8953.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8692.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6620.1, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9268.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12294.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12294.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9214.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11300.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14658.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9127.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9127.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13473.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15131.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15211.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7565.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7565.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9127.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8275.12, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12294.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8692.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8692.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15604.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8511.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8511.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2925.92 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8692.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8692.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9457.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7092.96, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8656, "minimum": 6059.417, "maximum": 15148.5425, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8396.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15148.54, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7827.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6670.21 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7982.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8656.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7982.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8222.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7982.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8656.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6059.42, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8656.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8483.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11253.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11253.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8461.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10377.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13417.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8381.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8381.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12373.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13850.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13969.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8656.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8656.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6925.05, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6925.05, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8381.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7574.27, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11253.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7982.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7982.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14282.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7790.68, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7790.68, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8656.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7773.14 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8656.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7982.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7982.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8656.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6492.23, "additional_payer_notes": "75.00% 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": 49712, "minimum": 34798.505, "maximum": 86996.2625, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48220.79, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 86996.26, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 64500.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 54965.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 44368.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 49712.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44368.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 45699.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 44368.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 49712.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34798.51, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49712.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 48717.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 64625.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 64625.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 47030.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 57679.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 77053.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46587.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 46587.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 68771.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 79539.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 77645.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 49712.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49712.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 39769.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39769.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 46587.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 43498.13, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 64625.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 44368.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44368.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 82025.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 44740.94, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 44740.94, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49712.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 86063.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 49712.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 44368.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44368.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 49712.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 37284.11, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10597, "minimum": 7418.593, "maximum": 18546.4825, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10280.05, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18546.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9937.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8468.13 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9703.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10597.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9703.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9994.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9703.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10597.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7418.59, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10597.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10386.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13777.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13777.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10285.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10800, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12614.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16426.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10188.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10188.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15040.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16956.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16980.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10597.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10597.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8478.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8478.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10188.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9273.24, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13777.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9703.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9703.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17486.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9538.19, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9538.19, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10597.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9705.79 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10597.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9703.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9703.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10597.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7948.49, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7857, "minimum": 4509.79, "maximum": 13751.3425, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7622.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13751.34, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5292.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4509.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7274.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 7857.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7274.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7493.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7274.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 7857.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5500.54, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7857.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 7700.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10215.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 10215.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7711.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 9457.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12179.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7638.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7638.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11276.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 12572.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 12731.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 7857.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7857.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6286.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6286.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7638.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 6875.67, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 10215.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7274.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7274.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 12965.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7072.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7072.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7857.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5889.62 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 7857.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7274.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7274.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 7857.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 5893.43, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12687, "minimum": 4562.76, "maximum": 22203.475, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12307.07, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22203.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12672.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10799.34 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12687.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11902.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12687.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8881.39, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12687.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12433.95, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16494.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16494.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12248.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 15022.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19665.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12133.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12133.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17911.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20300.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20222.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12687.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12687.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10150.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10150.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12133.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11101.74, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16494.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20934.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11418.93, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11418.93, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12687.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4562.76 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12687.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12687.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9515.78, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16459, "minimum": 11521.867, "maximum": 28804.6675, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15966.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28804.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17336.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14774.03 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14898.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16459.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14898.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15345.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14898.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16459.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11521.87, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16459.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16130.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21397.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21397.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15792.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 18450, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19368.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25512.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15643.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23092.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 26335.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 26072.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16459.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16459.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13167.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13167.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15643.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14402.33, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21397.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14898.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14898.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27158.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14813.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14813.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16459.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14397.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16459.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14898.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14898.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16459.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12344.86, "additional_payer_notes": "75.00% 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": 20581, "minimum": 14407.33, "maximum": 36018.325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19964.44, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36018.33, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22534.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 19202.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18551.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 20581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18551.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19108.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18551.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14407.33, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 20170.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26756.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 26756.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19664.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 24117.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31901.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19479.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19479.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28755.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 32931.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 32465.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 20581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16465.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16465.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 19479.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18009.16, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 26756.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18551.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18551.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 33960.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18523.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18523.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19071.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18551.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18551.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15436.43, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19683, "minimum": 13778.366, "maximum": 34445.915, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19092.88, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 34445.92, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19878.5 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16939.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17755.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 19683.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17755.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18288.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 17755.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19683.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13778.37, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19683.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 19289.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25588.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 25588.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18820.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 23082.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30509.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18643.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18643.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27521.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 31493.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 31072.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 19683.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19683.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 15746.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15746.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 18643.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17222.96, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 25588.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 17755.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17755.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 32477.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 17715.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 17715.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19683.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26723.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19683.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 17755.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17755.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19683.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14762.54, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13168, "minimum": 9218.041, "maximum": 23045.1025, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12773.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23045.1, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12469.11 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10625.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11981.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13168.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12341.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11981.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13168.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9218.04, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13168.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12905.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17119.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 17119.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12700.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 15576.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20411.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12580.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12580.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18571.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 21069.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20967.98, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13168.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13168.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10534.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10534.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12580.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11522.55, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 17119.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11981.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11981.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21728.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11851.77, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11851.77, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13168.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13330.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13168.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11981.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11981.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13168.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9876.47, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8920, "minimum": 6244.518, "maximum": 15611.295, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11596.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11596.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8709.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10682.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13827.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8627.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8627.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12736.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 14273.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14379.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8920.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8920.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7136.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7136.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8627.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7805.65, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11596.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8216.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8216.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14719.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8028.67, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8028.67, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8920.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8705.91 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8920.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8216.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8216.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8920.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6690.56, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8653.12, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15611.3, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7734.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6591.17 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8216.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8920.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8216.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8463.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8216.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8920.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6244.52, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8920.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8742.33, "additional_payer_notes": "98.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14707, "minimum": 6750, "maximum": 25737.6875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14266.03, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25737.69, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16781.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14300.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14707.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13745.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14707.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10295.08, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14707.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14413.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19119.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 19119.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14146.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 17348.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22796.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14012.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14012.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20685.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 23531.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 23354.28, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14707.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14707.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11765.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11765.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14012.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12868.84, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 19119.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24266.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13236.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13236.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14707.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15581.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14707.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13345.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14707.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11030.44, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21488, "minimum": 12150, "maximum": 37605.7325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20844.32, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 37605.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25445.67 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 21684.08 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 21488.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19936.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 19355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21488.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15042.29, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21488.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 21059.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 27935.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 27935.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20517.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 25162.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33307.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20323.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20323.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30001.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 34382.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 33872.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 21488.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21488.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 17191.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17191.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 20323.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18802.87, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 27935.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 19355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 35456.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 19340.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 19340.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21488.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25693.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21488.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 19355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21488.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 16116.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12913, "minimum": 9039.534, "maximum": 23312.8, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12526.21, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22598.84, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11802.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10058 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11755.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11755.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12108.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11755.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9039.53, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12655.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16787.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16787.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12461.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 15282.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20016.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12343.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12343.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18221.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20661.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20572.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10330.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10330.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12343.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11299.42, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16787.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11755.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11755.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21307.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11622.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11622.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23312.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11755.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11755.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9685.22, "additional_payer_notes": "75.00% 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": 12369, "minimum": 8658.559, "maximum": 21646.3975, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11998.29, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21646.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11475.5 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9779.09 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11273.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12369.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11273.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11611.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11273.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12369.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8658.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12369.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12121.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16080.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16080.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11949.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14655.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19172.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11836.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11836.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17473.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 19790.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 19728.28, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12369.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12369.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9895.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9895.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11836.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10823.2, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16080.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11273.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11273.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20409.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11132.43, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11132.43, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12369.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14740.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12369.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11273.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11273.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12369.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9277.03, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41775, "minimum": 19350, "maximum": 73106.53, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40521.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 73106.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 57718.65 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 49186.19 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 37334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 41775.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 38454.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 37334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 41775.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29242.61, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41775.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 40939.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 54307.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 54307.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 39574.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 48534.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 64751.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39201.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 39201.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 57868.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 66840.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 65335.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 41775.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41775.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 33420.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33420.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 39201.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 36553.27, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 54307.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 37334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 68929.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 37597.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 37597.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41775.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51263 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 41775.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 37334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37334.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 41775.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 31331.37, "additional_payer_notes": "75.00% 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": 18691, "minimum": 13084.106, "maximum": 32710.265, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18130.83, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32710.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19913.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16969.87 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16876.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 18691.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16876.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17382.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 16876.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18691.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13084.11, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18691.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 18317.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 24299.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 24299.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17889.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 21939.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28971.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17720.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17720.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26158.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 29906.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 29533.88, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 18691.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18691.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 14953.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14953.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 17720.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 16355.13, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 24299.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 16876.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16876.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 30841.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 16822.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 16822.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18691.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19473 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18691.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 16876.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16876.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18691.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14018.69, "additional_payer_notes": "75.00% 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": 14846, "minimum": 706, "maximum": 34200, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14401.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25981.8, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "per diem", "standard_charge_dollar": 938 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "per diem", "standard_charge_dollar": 706 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14846.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13872.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14846.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10392.72, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14846.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14549.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19300.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 19300.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14277.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 17509.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23012.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14142.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14142.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20876.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 23754.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 23570.58, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14846.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14846.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11877.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11877.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14142.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12990.9, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 19300.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24497.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13362.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13362.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14846.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6955.66 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14846.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13468.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14846.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11135.06, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33695, "minimum": 18450, "maximum": 58966.705, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32684.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 58966.71, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 35849.74 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 30550.13 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 30173.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 33695.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30173.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 31078.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 30173.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 33695.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23586.68, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33695.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 33021.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 43803.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 43803.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 31984.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 39225.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 52227.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31682.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 31682.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46769.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 53912.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 52803.8, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 33695.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33695.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 26956.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26956.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 31682.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 29483.35, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 43803.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 30173.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30173.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 55597.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 30325.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 30325.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33695.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37420.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 33695.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 30173.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30173.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 33695.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 25271.45, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8104, "minimum": 5673.052, "maximum": 18612.1, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7861.23, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14182.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7877.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6712.91 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7493.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8104.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7493.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7718.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7493.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8104.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5673.05, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8104.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 7942.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10535.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 10535.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7943.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 9741.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12561.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7868.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7868.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11614.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 12966.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13113.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8104.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8104.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6483.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6483.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7868.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7091.32, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 10535.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7493.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13372.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7293.92, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7293.92, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8104.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18612.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8104.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7493.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7493.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8104.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6078.27, "additional_payer_notes": "75.00% 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": 17666, "minimum": 706, "maximum": 30916.2, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17136.41, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 30916.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "per diem", "standard_charge_dollar": 938 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "per diem", "standard_charge_dollar": 706 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15967.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 17666.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15967.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16446.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15967.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17666.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12366.48, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17666.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 17313.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22966.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 22966.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16925.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 20758.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27382.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16766.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16766.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24750.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 28266.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 27943.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 17666.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17666.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 14133.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14133.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 16766.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 15458.1, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 22966.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15967.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15967.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 29149.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15899.76, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15899.76, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17666.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11079 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17666.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15967.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15967.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17666.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 13249.8, "additional_payer_notes": "75.00% 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": 9612, "minimum": 6728.519, "maximum": 16821.2975, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9612.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8829.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9094.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8829.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9612.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6728.52, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9612.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9419.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12495.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12495.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9359.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11478.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14898.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9271.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9271.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13686.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15379.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15452.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9612.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9612.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7689.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7689.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9271.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8410.65, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12495.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8829.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8829.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15860.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8650.95, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8650.95, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9612.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9442.12 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9612.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8829.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8829.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9612.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7209.13, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9323.8, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16821.3, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8433.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7187.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8829.73, "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": 10287, "minimum": 706, "maximum": 18002.8625, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9978.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18002.86, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "per diem", "standard_charge_dollar": 938 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "per diem", "standard_charge_dollar": 706 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9428.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10287.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9428.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9710.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9428.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10287.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7201.15, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10287.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10081.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13373.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13373.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9993.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12256.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15945.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9899.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9899.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16459.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16499.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10287.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10287.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8229.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8229.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9899.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9001.43, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13373.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9428.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9428.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16974.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9258.62, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9258.62, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10287.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9428.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9428.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10287.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7715.51, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8011, "minimum": 706, "maximum": 14020.895, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7771.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14020.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "per diem", "standard_charge_dollar": 938 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "per diem", "standard_charge_dollar": 706 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7411.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8011.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7411.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7633.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7411.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8011.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5608.36, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8011.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 7851.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10415.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 10415.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7856.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 9634.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12418.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7782.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7782.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11487.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 12819.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 12970.14, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8011.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8011.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6409.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6409.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7782.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7010.45, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 10415.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7411.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7411.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13219.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7210.75, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7210.75, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8011.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3646.05 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8011.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7411.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7411.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8011.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6008.96, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17123, "minimum": 11986.1, "maximum": 29965.25, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15486.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15486.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 28252.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15410.7, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15410.7, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17123, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14552.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17123, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15486.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15486.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17123, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12842.25, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16609.31, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29965.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18098.11 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15422.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15486.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 17123, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15486.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15950.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15486.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17123, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11986.1, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17123, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16780.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22259.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 22259.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16415.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 20132.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26540.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16260.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16260.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24003.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 27396.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 27101.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 17123, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17123, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13698.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13698.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 16260.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14982.63, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 22259.9, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8434, "minimum": 4174.34, "maximum": 14760.69, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8181.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14760.69, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7007.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5971.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7786.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7786.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8019.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7786.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5904.28, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8265.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10965.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 10965.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8253.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10122.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13073.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8175.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8175.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12068.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13495.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13625.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6747.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6747.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8175.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7380.35, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 10965.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7786.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7786.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13917.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7591.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7591.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4174.34 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7786.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7786.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6326.01, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 105574, "minimum": 73902.402, "maximum": 184756.005, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 102407.61, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 184756.01, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 93877.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 105574.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 93877.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 96694.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 93877.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 105574.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 73902.4, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 105574.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 103463.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 137247.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 137247.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 99510.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 122041.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 163641.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 98571.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 98571.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 145510.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 168919.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 164285.98, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 105574.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 105574.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 84459.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 84459.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 98571.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 92378, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 137247.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 93877.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 93877.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 174198.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 95017.37, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 95017.37, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 105574.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 111000 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 105574.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 93877.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 93877.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 105574.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 79181.15, "additional_payer_notes": "75.00% 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": 44849, "minimum": 31394.888, "maximum": 78487.22, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43504.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 78487.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 51265.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 43687.04 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 40059.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 44849.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40059.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 41261.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 40059.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 44849.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31394.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44849.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 43952.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 58304.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 58304.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 42463.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 52077.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 69517.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42062.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 42062.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 62092.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 71759.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 70104.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 44849.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 44849.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 35879.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35879.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 42062.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 39243.61, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 58304.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 40059.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40059.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 74002.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 40364.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 40364.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44849.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37399.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 44849.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 40059.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40059.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 44849.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 33637.38, "additional_payer_notes": "75.00% 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": 14579, "minimum": 10205.818, "maximum": 25514.545, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14142.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25514.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16965.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14457.87 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13232.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14579.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13232.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13629.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13232.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14579.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10205.82, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14579.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14288.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18953.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 18953.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14026.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 17201.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22598.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13893.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13893.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20510.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 23327.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 23156.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14579.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14579.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11663.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11663.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13893.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12757.27, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 18953.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13232.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13232.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24056.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13121.77, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13121.77, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14579.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15839.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14579.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13232.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13232.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14579.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10934.81, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18737, "minimum": 13116.453, "maximum": 32791.1325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18175.66, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32791.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21685.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 18479.8 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16917.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 18737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16917.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17424.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 16917.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13116.45, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 18363.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 24359.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 24359.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17932.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 21992.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29043.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17763.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17763.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26221.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 29980.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 29605.45, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 18737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 14990.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14990.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 17763.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 16395.57, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 24359.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 16917.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16917.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 30917.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 16864.01, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 16864.01, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14365.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 16917.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16917.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14053.34, "additional_payer_notes": "75.00% 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": 22206, "minimum": 15544.872, "maximum": 38862.18, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21540.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 38862.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23385.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 19928.86 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19992, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 22206.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19992, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20591.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 19992, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 22206.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15544.87, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22206.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 21762.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 28869.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 28869.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21191.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 25989.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 34420.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20991.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20991.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30987.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 35531.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 34986, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 22206.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22206.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 17765.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17765.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 20991.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 19431.09, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 28869.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 19992, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19992, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 36641.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 19986.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 19986.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22206.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19760.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 22206.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 19992, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19992, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 22206.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 16655.22, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14869, "minimum": 10408.888, "maximum": 26022.22, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14423.74, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26022.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13891.28 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 11837.76 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13489.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13489.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13894.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13489.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10408.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14572.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19330.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 19330.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14298.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 17536.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23048.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14163.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14163.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20908.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 23791.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 23606.45, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11895.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11895.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14163.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13011.11, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 19330.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13489.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13489.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24535.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13382.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13382.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13061.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13489.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13489.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11152.38, "additional_payer_notes": "75.00% 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": 39468, "minimum": 27628.258, "maximum": 69070.645, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38284.87, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 69070.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 43420.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 37001.39 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 35290.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 39468.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35290.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 36349.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 35290.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 39468.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27628.26, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39468.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 38679.56, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 51309.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 51309.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 37408.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 45900, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 31500, "10th_percentile": 31500, "90th_percentile": 31500, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 45877.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 61176.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37055.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 37055.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 54700.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 63150.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 61758.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 39468.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39468.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 31575.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31575.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 37055.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 34535.32, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 51309.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 35290.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35290.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 65123.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 35522.05, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 35522.05, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39468.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54515 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 39468.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 35290.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35290.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 39468.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 29601.71, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Amputation toe & metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28231.81, "discounted_cash": 3270, "minimum": 1500, "maximum": 27667.1738, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3202.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3038.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2289.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 2463.53, "10th_percentile": 2463.53, "90th_percentile": 2463.53, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5723.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2861.95, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2453.1, "additional_payer_notes": "75.00% 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": 12832, "minimum": 8131.32, "maximum": 22456.56, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12447.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22456.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12364.63 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10536.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11683.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12832.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11683.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12034.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11683.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12832.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8982.62, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12832.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12575.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16682.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16682.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12384.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 15188.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19890.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12267.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18109.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20531.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20446.3, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12832.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12832.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10265.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10265.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12267.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11228.28, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16682.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11683.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21173.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11549.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11549.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12832.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8131.32 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12832.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11683.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11683.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12832.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9624.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10182, "minimum": 6974.56, "maximum": 17820.1625, "payers_information": [ { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12136.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15783.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9802.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9802.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14470.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16292.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16337.28, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10182.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10182.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8146.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8146.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9802.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8910.08, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13237.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9335.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9335.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16801.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9164.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9164.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10182.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6974.56 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10182.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9335.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9335.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10182.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7637.21, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9877.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17820.16, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10440.32 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8896.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9335.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10182.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9335.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9615.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9335.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10182.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7128.07, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10182.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9979.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13237.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13237.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9895.73, "additional_payer_notes": "106.00% 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": 27125, "minimum": 18988.025, "maximum": 47470.0625, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26311.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 47470.06, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 29744.19 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 25347.15 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 24351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 27125.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 25081.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 24351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 27125.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18988.03, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27125.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 26583.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 35263.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 35263.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25812.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 32850, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 22500, "10th_percentile": 22500, "90th_percentile": 63000, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 31656.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 42044.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25568.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 25568.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37744.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 43401.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 42614.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 27125.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27125.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 21700.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21700.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 25568.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 23735.03, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 35263.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 24351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 44757.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 24413.18, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 24413.18, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27125.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19695.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 27125.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 24351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 27125.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 20344.31, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22377, "minimum": 15664.075, "maximum": 39160.1875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21705.93, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 39160.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26243.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 22363.64 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 20142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 22377.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20747.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 20142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 22377.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15664.08, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22377.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 21929.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 29090.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 29090.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21351.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 26185.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 34684.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21150.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 21150.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31221.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 35803.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 35250.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 22377.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22377.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 17901.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17901.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 21150.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 19580.09, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 29090.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 20142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 36922.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 20139.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 20139.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22377.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24827.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 22377.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 20142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 22377.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 16782.94, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13932, "minimum": 9752.967, "maximum": 24382.4175, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13514.83, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24382.42, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14311.33 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12195.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12658.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13932.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12658.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13038.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 12658.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13932.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9752.97, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13932.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 13654.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18112.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 18112.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13418.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16456.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21595.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13291.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13291.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19621.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 22292.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 22153.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13932.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13932.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11146.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11146.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13291.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12191.21, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 18112.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 12658.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12658.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 22989.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12539.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12539.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13932.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12699.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13932.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 12658.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12658.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13932.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10449.61, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29891 - ", "code_information": [ { "code": "29891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9432.75, "discounted_cash": 3270, "minimum": 543.3264, "maximum": 9244.095, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3202.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3038.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2289.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5723.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2861.95, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2453.1, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8739, "minimum": 6117.524, "maximum": 15293.81, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8477.14, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15293.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7430.72 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6332.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8056.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8739.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8056.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8297.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8056.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8739.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6117.52, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8739.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8564.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11361.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11361.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8539.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9000, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10473, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13545.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8458.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8458.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12487.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13982.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14098.26, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8739.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8739.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6991.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6991.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8458.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7646.91, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11361.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8056.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8056.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14419.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7865.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7865.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8739.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6239.31 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8739.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8056.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8056.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8739.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6554.49, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29897 - ", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13625.08, "discounted_cash": 3270, "minimum": 784.8046, "maximum": 13352.5784, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3202.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3038.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2289.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5723.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2861.95, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2453.1, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32575, "minimum": 22803.172, "maximum": 57007.93, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31598.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 57007.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 42524.6 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 36238.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 29181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 32575.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 30057.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 29181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 32575.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22803.17, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32575.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 31924.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 42348.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 42348.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30932.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 37936.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 50492.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30640.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 30640.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45231.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 52121.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 51067.8, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 32575.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32575.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 26060.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26060.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 30640.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 28503.97, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 42348.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 29181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 53750.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 29318.36, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 29318.36, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32575.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23204.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 32575.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 29181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 32575.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 24431.97, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3144.25, "discounted_cash": 3270, "minimum": 181.1088, "maximum": 3144.25, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3144.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3038.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3144.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3144.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2289.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2861.95, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3144.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2453.1, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41923.3, "discounted_cash": 3270, "minimum": 1500, "maximum": 41084.834, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3202.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3038.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2289.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5723.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2861.95, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2453.1, "additional_payer_notes": "75.00% 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": 38872, "minimum": 6482.18, "maximum": 68026.8575, "payers_information": [ { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 34985.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 34985.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38872.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6482.18 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 38872.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 34762, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34762, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 38872.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 29154.37, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37706.32, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 68026.86, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 45997.95 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 39198.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 34762, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 38872.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34762, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 35804.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 34762, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 38872.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27210.74, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38872.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 38095.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 50534.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 50534.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 36847.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 45190.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 60252.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36500.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 36500.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53881.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 62195.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 60833.5, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 38872.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38872.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 31097.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31097.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 36500.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 34013.43, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 50534.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 34762, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34762, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 64139.61, "additional_payer_notes": "165.00% of Medicare Rates" } ] } ] }, { "description": "ANTERIOR COLPORRHAPHY, REPAIR CYSTOCELE", "code_information": [ { "code": "57240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22921.99, "discounted_cash": 5000, "minimum": 1320.3066, "maximum": 22463.5502, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4850.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10001.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4997.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4741.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5553 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5553 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5150.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7500.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3500.43, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 4900.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7000.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5300.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8751.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4000.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4000.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4375.54, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8251.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6250.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 4500.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 4500.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 3750.47, "additional_payer_notes": "75.00% 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": 61589, "minimum": 14260, "maximum": 107782.185, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 59742.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 107782.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 74142.99 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 63182.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 54895.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 61589.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 54895.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 56542.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 54895.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 61589.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43112.87, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61589.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 60358.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 80066.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 80066.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 58189.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 71364.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 95464.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57640.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 57640.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 85088.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 98543.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 96067.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 61589.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 61589.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 49271.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49271.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 57640.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 53891.09, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 80066.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 54895.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 54895.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 101623.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 55430.84, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 55430.84, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 61589.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14260 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 61589.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 54895.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 54895.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 61589.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 46192.37, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8493, "minimum": 4923.77, "maximum": 14864.01, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8238.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14864.01, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7211.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6145.09 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7838.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8493.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7838.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8073.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7838.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8493.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5945.6, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8493.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8323.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11041.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11041.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8308.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10190.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13165.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8230.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8230.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12149.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13589.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13717.36, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8493.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8493.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6794.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6794.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8230.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7432.01, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11041.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7838.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7838.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14014.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7644.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7644.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8493.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4923.77 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8493.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7838.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7838.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8493.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6370.29, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Artery-Vein Autograft", "code_information": [ { "code": "36825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28298.3, "discounted_cash": 5562, "minimum": 1500, "maximum": 27732.334, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9734.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4867.14, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 4171.84, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5377.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5101.77 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5975.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5975.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3893.72, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5451.2, "additional_payer_notes": "98.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15685, "minimum": 10979.752, "maximum": 47894.21, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15214.8, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27449.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14212.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 15685.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14212.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14638.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14212.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15685.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10979.75, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15685.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15371.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20390.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 20390.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15064.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 18475.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24312.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14922.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14922.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22028.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 25096.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 24871.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 15685.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15685.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12548.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12548.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14922.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13724.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 20390.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14212.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 25880.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14116.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14116.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15685.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24716.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15685.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14212.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14212.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15685.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11764.02, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15206.47, "maximum": 19826.161, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17844.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15206.47 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18427.8 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23227, "minimum": 16258.9, "maximum": 67749.19, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22530.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 40647.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 20896, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 23227, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20896, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 21522.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 20896, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23227, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16258.9, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23227, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 22762.46, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 30195.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 30195.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22149.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 27164.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36001.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21940.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 21940.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32388.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 37163.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 36568, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 23227, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23227, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 18581.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18581.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 21940.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 20323.63, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 30195.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 20896, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20896, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 38324.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 20904.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 20904.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23227, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27487.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 23227, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 20896, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20896, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23227, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 17420.25, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Av Fuse Uppr Arm Basilic", "code_information": [ { "code": "36819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56563.2, "discounted_cash": 5562, "minimum": 1500, "maximum": 55431.936, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5377.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5101.77 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5975.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5975.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3893.72, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5451.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9734.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4867.14, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 4634.57, "10th_percentile": 4634.57, "90th_percentile": 4634.57, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 4171.84, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12528, "minimum": 8550, "maximum": 38445.38, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12152.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21924.95, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12528.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11756.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12528.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8769.98, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12528.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12277.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16287.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16287.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12099.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19419.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11985.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11985.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17692.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20045.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 19975.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12528.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12528.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10022.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10022.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11985.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10962.47, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16287.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20672.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11275.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11275.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12528.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15897.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12528.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12528.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9396.41, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Av Fusion Direct Any Site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29362.9, "discounted_cash": 3156, "minimum": 1500, "maximum": 28775.642, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3242.4 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3076.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3602.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3602.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2209.42, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3093.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1987.12, "10th_percentile": 1987.12, "90th_percentile": 1987.12, "count": "1 through 10" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5523.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2525.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2525.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2761.78, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2840.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2840.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2367.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Artery-Vein Nonautograft", "code_information": [ { "code": "36830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44161.5, "discounted_cash": 5562, "minimum": 1500, "maximum": 43278.27, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5377.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5101.77 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5975.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5975.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3893.72, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5451.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9734.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4867.14, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 4171.84, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Arthrodesis Subtalar", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53452.3, "discounted_cash": 12833, "minimum": 1500, "maximum": 52383.254, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12448.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25667.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13923.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13209.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15470.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15470.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13219, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 19250.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8983.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 12577.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17967.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22459.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 11229.73, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 16042.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 9625.49, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53475, "minimum": 37432.983, "maximum": 93582.4575, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51871.42, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 93582.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 47704.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 53475.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47704.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 49135.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 47704.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 53475.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37432.98, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53475.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 52406.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 69518.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 69518.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 50566.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 62015.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 82887.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50089.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 50089.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 73941.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 85561.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 83482.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 53475.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 53475.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 42780.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42780.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 50089.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 46791.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 69518.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 47704.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47704.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 88234.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 48128.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 48128.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53475.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47469.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 53475.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 47704.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47704.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 53475.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 40106.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12972, "minimum": 9080.862, "maximum": 22702.155, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12583.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22702.16, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11657.8 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9934.45 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12972.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12162.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12972.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9080.86, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12972.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12713.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16864.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16864.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12516.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 15350.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20107.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12398.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12398.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20756.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20664, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12972.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12972.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10378.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10378.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12398.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11351.08, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16864.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21404.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11675.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11675.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12972.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12203.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12972.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12972.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9729.5, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49219, "minimum": 34453.468, "maximum": 86133.67, "payers_information": [ { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 81211.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 44297.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 44297.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49219.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63317.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 49219.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 43931.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43931.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 49219.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 36914.43, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47742.66, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 86133.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 43931.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 49219.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43931.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 45249.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 43931.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 49219.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34453.47, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49219.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 48234.86, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 63985.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 63985.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 46567.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 57111.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 76289.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46128.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 46128.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 68094.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 78750.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 76880.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 49219.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49219.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 39375.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39375.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 46128.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 43066.84, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 63985.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 43931.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43931.9, "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": 43364.6, "discounted_cash": 5562, "minimum": 1500, "maximum": 42497.308, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5377.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5101.77 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5975.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5975.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3893.72, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5451.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9734.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4867.14, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 4171.84, "additional_payer_notes": "75.00% 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": 15516, "minimum": 9000, "maximum": 27154.365, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15051.28, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27154.37, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15110.9 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12877.08 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14062.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 15516.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14062.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14484.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14062.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15516.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10861.75, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15516.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15206.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20171.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 20171.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14906.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 18281.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24051.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14765.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14765.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21797.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 24826.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 24609.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 15516.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15516.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12413.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12413.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14765.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13577.18, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 20171.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14062.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14062.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 25602.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13965.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13965.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15516.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16499.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15516.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14062.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14062.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15516.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11637.59, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23777, "minimum": 16644.068, "maximum": 41610.17, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23063.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41610.17, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25126.91 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 21412.44 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21383.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 23777.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21383.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22025.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 21383.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23777.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16644.07, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23777.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 23301.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 30910.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 30910.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22666.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 27798.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36854.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22452.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 22452.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33144.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 38043.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 37421.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 23777.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23777.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 19021.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19021.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 22452.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 20805.09, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 30910.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 21383.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21383.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 39232.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 21399.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 21399.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23777.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18837 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 23777.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 21383.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21383.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23777.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 17832.93, "additional_payer_notes": "75.00% 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": 24804, "minimum": 17362.891, "maximum": 43407.2275, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24060.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 43407.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26737.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 22785.18 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22962.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17362.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 24308.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 32245.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 32245.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 28981.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 38446.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23408.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 23408.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34555.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 39686.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 39014.15, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 19843.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19843.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 23408.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 21703.61, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 32245.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 40926.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 22323.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 22323.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24071.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 18603.1, "additional_payer_notes": "75.00% 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": 34714, "minimum": 24300, "maximum": 60750.2875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33673.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 60750.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 38212.22 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 32563.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 31076.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 34714.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31076.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 32009.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 31076.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 34714.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24300.12, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34714.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 34020.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 45128.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 45128.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 32941.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 40399.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 53807.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32630.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 32630.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 48169.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 55543.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 54384.58, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 34714.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34714.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 27771.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27771.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 32630.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 30375.14, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 45128.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 31076.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31076.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 57278.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 31243.01, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 31243.01, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34714.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31142.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 34714.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 31076.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31076.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 34714.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 26035.84, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Vulva/Perineum", "code_information": [ { "code": "56605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11637.6, "discounted_cash": 920, "minimum": 52.8804, "maximum": 11404.848, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 893.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1841.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 55.74 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 52.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 61.93 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 61.93 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1381.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 644.5, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 902.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1288.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1196.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1427.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1611.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 736.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 736.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 805.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 1150.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 828.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 828.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 690.53, "additional_payer_notes": "75.00% 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": 19849, "minimum": 13894.573, "maximum": 34736.4325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19253.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 34736.43, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20871.04 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 17785.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17902.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 19849.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17902.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18439.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 17902.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19849.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13894.57, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19849.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 19452.4, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25804.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 25804.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18976.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 23273.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30766.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18797.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18797.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27749.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 31759.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 31329.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 19849.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19849.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 15879.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15879.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 18797.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17368.22, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 25804.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 17902.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17902.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 32751.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 17864.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 17864.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19849.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21060.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19849.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 17902.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17902.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19849.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14887.04, "additional_payer_notes": "75.00% 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": 49995, "minimum": 31950, "maximum": 87491.95, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48495.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 87491.95, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 64778.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 55202.28 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 44619.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 49995.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44619.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 45958.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 44619.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 49995.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34996.78, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49995.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 48995.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 64994.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 64994.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 47296.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 58005.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 77492.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46850.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 46850.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 69160.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 79992.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 78084.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 49995.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49995.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 39996.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39996.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 46850.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 43745.98, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 64994.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 44619.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44619.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 82492.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 44995.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 44995.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49995.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64374.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 49995.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 44619.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44619.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 49995.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 37496.55, "additional_payer_notes": "75.00% 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": 16319, "minimum": 11423.622, "maximum": 28559.055, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15829.88, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28559.06, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16691.93 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14224.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14774.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16319.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14774.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15217.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14774.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16319.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11423.62, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16319.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15993.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21215.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21215.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15660.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19206.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25295.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15512.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15512.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22899.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 26111.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 25854.68, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16319.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16319.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13055.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13055.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15512.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14279.53, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21215.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14774.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14774.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 26927.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14687.51, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14687.51, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16319.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19590.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16319.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14774.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14774.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16319.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12239.6, "additional_payer_notes": "75.00% 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": 32849, "minimum": 22994.853, "maximum": 57487.1325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31864.3, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 57487.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 38732.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 33006.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 29424.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 32849.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29424.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 30307.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 29424.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 32849.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22994.85, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32849.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 32192.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 42704.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 42704.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 31189.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 38251.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 50917.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30895.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 30895.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45607.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 52559.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 51492.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 32849.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32849.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 26279.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26279.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 30895.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 28743.57, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 42704.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 29424.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29424.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 54202.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 29564.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 29564.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32849.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31185.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 32849.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 29424.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29424.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 32849.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 24637.34, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12746, "minimum": 8922.725, "maximum": 22306.8125, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12188.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17992.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20394.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20313.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12746.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12746.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10197.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10197.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12188.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11153.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16570.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21032.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11472.08, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11472.08, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12746.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13245 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12746.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12746.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9560.06, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12364.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22306.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13666.34 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 11646.06 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12746.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11956.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12746.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8922.73, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12746.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12491.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16570.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16570.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12304.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 15090.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19757.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12188.19, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Cervix", "code_information": [ { "code": "57500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10991, "discounted_cash": 920, "minimum": 108.9576, "maximum": 10771.18, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 893.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1841.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 114.85 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 108.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 127.61 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 127.61 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1381.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 644.5, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 902.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1288.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1196.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1427.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1611.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 736.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 736.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 966.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 805.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 1150.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 828.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 828.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 920.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 690.53, "additional_payer_notes": "75.00% 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": 24804, "minimum": 17362.891, "maximum": 43407.2275, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24060.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 43407.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24856.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 21181.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22962.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17362.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 24308.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 32245.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 32245.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 28981.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 38446.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23408.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 23408.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34555.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 39686.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 39014.15, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 19843.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19843.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 23408.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 21703.61, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 32245.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 40926.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 22323.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 22323.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18407 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 24804.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 18603.1, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW HARVEST AUTOLOG", "code_information": [ { "code": "38232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9432.75, "discounted_cash": 4353, "minimum": 543.3264, "maximum": 9244.095, "payers_information": [ { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 3265.43, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4223.28, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 8707.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4467.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4238.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4963.87 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4963.87 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4484.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 6530.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3047.73, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 4266.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6095.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5660.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4615.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5660.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6748.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4571.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4571.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6748.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7619.33, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 3483.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3483.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 4571.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3809.66, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5660.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 7183.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 5442.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3918.51, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3918.51, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 4353.9, "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": 20492, "minimum": 706, "maximum": 35861.0875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19877.29, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 35861.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "per diem", "standard_charge_dollar": 938 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "per diem", "standard_charge_dollar": 706 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18472.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 20492.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18472.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19026.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18472.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20492.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14344.44, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20492.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 20082.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26639.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 26639.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19580.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 24013.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31762.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19395.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19395.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28631.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 32787.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 32326.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 20492.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20492.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16393.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16393.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 19395.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17930.54, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 26639.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18472.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18472.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 33811.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18442.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18442.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20492.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11602.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20492.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18472.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18472.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20492.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15369.04, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13825, "minimum": 9678.088, "maximum": 24195.22, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13411.06, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24195.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13521.35 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 11522.51 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12564.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13825.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12564.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12941.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 12564.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13825.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9678.09, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13825.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 13549.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17973.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 17973.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13317.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16333.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21430.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13192.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13192.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19474.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 22121.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 21987.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13825.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13825.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11060.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11060.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13192.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12097.61, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 17973.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 12564.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12564.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 22812.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12443.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12443.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13825.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13700.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13825.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 12564.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12564.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13825.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10369.38, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21364, "minimum": 14955.437, "maximum": 37388.5925, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20723.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 37388.59, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22540.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 19208.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 21364.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19823.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 19245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21364.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14955.44, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21364.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 20937.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 27774.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 27774.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20400.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 25019.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33115.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20207.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20207.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29830.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 34183.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 33679.98, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 21364.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21364.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 17091.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17091.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 20207.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18694.3, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 27774.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 19245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 35252.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 19228.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 19228.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21364.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25604.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21364.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 19245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21364.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 16023.68, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8911, "minimum": 3681.96, "maximum": 15594.81, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8643.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15594.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7924.32 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6752.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8208.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8911.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8208.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8454.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8208.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8911.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6237.92, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8911.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8733.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11584.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11584.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8701.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10671.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13812.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8619.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8619.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12723.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 14258.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14365.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8911.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8911.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7129.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7129.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8619.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7797.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11584.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8208.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8208.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14703.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8020.19, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8020.19, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8911.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3681.96 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8911.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8208.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8208.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8911.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6683.49, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33245, "minimum": 23271.605, "maximum": 58179.0125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32247.8, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 58179.01, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 39973.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 34064.21 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 29774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 33245.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 30667.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 29774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 33245.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23271.61, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33245.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 32580.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 43218.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 43218.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 31561.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 38707.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 51529.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31263.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 31263.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46150.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 53192.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 52105.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 33245.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33245.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 26596.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26596.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 31263.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 29089.51, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 43218.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 29774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 54854.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 29920.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 29920.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33245.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55119.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 33245.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 29774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 33245.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 24933.86, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32295, "minimum": 22606.689, "maximum": 56516.7225, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31326.41, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 56516.72, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 35787.91 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 30497.44 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 28932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 32295.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 29800.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 28932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 32295.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22606.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32295.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 31649.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 41983.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 41983.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30668.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 37612.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 50057.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30379.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 30379.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44846, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 51672.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 50632.58, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 32295.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32295.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 25836.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25836.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 30379.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 28258.36, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 41983.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 28932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 53287.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 29065.74, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 29065.74, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32295.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42215.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 32295.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 28932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28932.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 32295.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 24221.45, "additional_payer_notes": "75.00% 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": 25495, "minimum": 9900, "maximum": 44617.23, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24730.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 44617.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 33520.32 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 28565.06 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 22906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 25495.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 23593.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 22906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 25495.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17846.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25495.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 24985.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 33144.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 33144.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24281, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 29778.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 39518.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24051.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 24051.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35505.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 40792.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 40086.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 25495.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25495.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 20396.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20396.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 24051.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 22308.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 33144.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 22906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 42067.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 22946, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 22946, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25495.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22457.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 25495.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 22906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 25495.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 19121.67, "additional_payer_notes": "75.00% 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": 18640, "minimum": 13048.161, "maximum": 32620.4025, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18081.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32620.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19288.95 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16437.49 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16830.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 18640.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16830.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17335.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 16830.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18640.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13048.16, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18640.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 18267.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 24232.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 24232.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17840.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 21880.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28892.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17672.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17672.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26087.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 29824.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 29454.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 18640.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18640.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 14912.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14912.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 17672.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 16310.2, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 24232.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 16830.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16830.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 30756.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 16776.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 16776.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18640.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15827.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18640.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 16830.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16830.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18640.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 13980.17, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11043, "minimum": 6913.13, "maximum": 19326.7025, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10712.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19326.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10294.26 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8772.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11043.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10401.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11043.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7730.68, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11043.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10822.95, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14356.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14356.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17117.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10603.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10603.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15652.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 17670.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 17672.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11043.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11043.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8835.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8835.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10603.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9663.35, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14356.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18222.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9939.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9939.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11043.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6913.13 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11043.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10098.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11043.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8282.87, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38510 - OR36038510", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14046.9, "discounted_cash": 3914, "minimum": 809.1014, "maximum": 13765.962, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3796.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7828, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3544.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3362.8 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3938.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3938.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4031.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5871, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2739.8, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3835.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6849.5, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 3131.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3131.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3424.75, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4892.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3522.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3522.6, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2935.5, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Prostate", "code_information": [ { "code": "55700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11832.8, "discounted_cash": 2004, "minimum": 517.2595, "maximum": 11596.144, "payers_information": [ { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 2104.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1753.8, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2605.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3307.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2505.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1803.91, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1803.91, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1503.26, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1944.21, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4008.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2072.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1966.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2064.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3006.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1403.04, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1964.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2806.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2605.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2605.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3106.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2104.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3507.6, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2004.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1603.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1603.47, "additional_payer_notes": "80.00% of Medicare Rates" } ] } ] }, { "description": "Bronchoscopy W/Biopsy(S)", "code_information": [ { "code": "31625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 1779, "minimum": 431.0294, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1725.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3558.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1673.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1587.98 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1859.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1859.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1832.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2668.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1245.47, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1743.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2490.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2313.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1868.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3113.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1423.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1423.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1868.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1556.84, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2224.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1601.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1601.32, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1334.43, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSYREMOVAL LYMPH NODES", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14411.14, "discounted_cash": 3914, "minimum": 830.0817, "maximum": 14122.9172, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3796.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7828, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3544.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3362.8 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3938.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3938.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4031.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5871, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2739.8, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3835.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6849.5, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 3131.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3131.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3424.75, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4892.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3522.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3522.6, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2935.5, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38525 - OR36038525", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11460.8, "discounted_cash": 3914, "minimum": 660.1421, "maximum": 11231.584, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3796.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7828, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3544.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3362.8 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3938.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3938.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 4031.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5871, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2739.8, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3835.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5479.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6066.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6849.5, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 3131.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3131.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 4109.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3424.75, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4892.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3522.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3522.6, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2935.5, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8466, "minimum": 4468.25, "maximum": 14816.095, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8212.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14816.1, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7521.34 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6409.47 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7814.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8466.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7814.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8048.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7814.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8466.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5926.44, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8466.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8297.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11006.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11006.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8283.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10158.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13122.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8204.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8204.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12112.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13546.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13674.89, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8466.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8466.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6773.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6773.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8204.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7408.05, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11006.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7814.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7814.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13969.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7619.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7619.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8466.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4468.25 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8466.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7814.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7814.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8466.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6349.76, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Bone Biopsy Open Superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25154, "discounted_cash": 2903, "minimum": 684.9504, "maximum": 24650.92, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9836, "minimum": 5256.43, "maximum": 17213.665, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9541.29, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17213.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8426.45 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7180.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9028.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9836.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9028.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9299.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9028.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9836.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6885.47, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9836.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9639.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12787.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12787.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9570.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11736.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15246.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9479.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13994.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15738.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15799.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9836.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9836.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7869.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7869.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9479.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8606.83, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12787.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9028.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16230.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8852.74, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8852.74, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9836.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5256.43 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9836.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9028.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9028.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9836.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7377.29, "additional_payer_notes": "75.00% 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": 19240, "minimum": 9900, "maximum": 33671.68, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18663.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 33671.68, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18513.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15777.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17363.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 19240.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17363.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17884.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 17363.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19240.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13468.67, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19240.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 18856.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25013.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 25013.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18405.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 22572.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29823.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18231.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18231.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26913.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 30785.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 30385.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 19240.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19240.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 15392.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15392.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 18231.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 16835.84, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 25013.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 17363.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17363.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 31747.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 17316.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 17316.86, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19240.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28586.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19240.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 17363.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17363.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19240.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14430.72, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21051, "minimum": 14736.197, "maximum": 36840.4925, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20420.16, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36840.49, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19448.86 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16573.77 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18968.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 21051.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18968.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19537.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18968.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21051.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14736.2, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21051.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 20630.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 27367.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 27367.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20106.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 24658.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32630.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19916.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19916.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29400.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 33682.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 33194.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 21051.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21051.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16841.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16841.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 19916.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18420.25, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 27367.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18968.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18968.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 34735.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18946.54, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18946.54, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21051.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30221.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21051.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18968.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18968.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21051.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15788.78, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Bronch Ebus Samplng 1/2 Node", "code_information": [ { "code": "31652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13406.3, "discounted_cash": 3726, "minimum": 772.2029, "maximum": 13138.174, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3615.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7453.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3436.18 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3259.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3817.98 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3817.98 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3838.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5590.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2608.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3652.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5217.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4845.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3950.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4845.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5776.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3913.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3913.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5776.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6522.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2981.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2981.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3913.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3261.11, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4845.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6149.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4658.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3354.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3354.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2795.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Bronch Ebus Samplng 3/> Node", "code_information": [ { "code": "31653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17817.4, "discounted_cash": 3726, "minimum": 892.2298, "maximum": 17461.052, "payers_information": [ { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2795.24, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3615.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7453.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3436.18 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3259.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3817.98 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3817.98 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3838.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5590.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2608.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3652.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5217.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4845.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3950.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4845.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5776.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3913.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3913.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5776.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6522.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2981.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2981.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3913.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3261.11, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4845.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6149.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4658.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3354.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3354.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3726.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6627, "minimum": 4435.3, "maximum": 11597.8625, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6428.53, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11597.86, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5204.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4435.3 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 6184.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 6627.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6184.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 6369.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 6184.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 6627.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4639.15, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6627.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 6494.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 8615.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 8615.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 6555.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 8039.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10272.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6493.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6493.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9585.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 10603.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 10822.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 6627.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6627.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 5301.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5301.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 6493.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 5798.93, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 8615.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 6184.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6184.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 10935.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 5964.62, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 5964.62, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6627.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4633.64 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 6627.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 6184.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6184.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 6627.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 4970.51, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9028, "minimum": 5017.33, "maximum": 15799.98, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8757.7, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15799.98, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7989.35 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6808.3 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8312.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9028.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8312.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8561.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8312.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9028.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6319.99, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9028.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8847.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11737.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11737.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8811.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10350, "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": 13500, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10806.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13994.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8728.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8728.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12884.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 14445.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14546.88, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9028.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9028.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7222.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7222.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8728.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7899.99, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11737.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8312.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8312.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14897.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8125.7, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8125.7, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5017.33 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9028.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8312.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8312.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9028.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6771.42, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Bx Breast Percut W/O Image", "code_information": [ { "code": "19100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 1650, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13035, "minimum": 9064.1, "maximum": 22812.9825, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12457.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18389.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20857.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20762.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13035.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13035.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10428.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10428.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12457.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11406.49, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16946.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11864.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11864.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21509.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11732.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11732.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13035.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9064.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13035.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11864.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11864.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13035.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9776.99, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12644.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22812.98, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12785.74 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10895.64 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11864.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13035.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11864.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12220.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11864.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13035.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9125.19, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13035.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12775.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16946.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16946.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12575.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 15423.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20205.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12457.31, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7577, "minimum": 4262.23, "maximum": 13260.135, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7349.9, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13260.14, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5953.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5073.06 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7026.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 7577.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7026.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7237.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7026.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 7577.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5304.05, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7577.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 7425.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9850.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 9850.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7447.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 9134.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11744.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7377.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7377.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10890.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 12123.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 12295.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 7577.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7577.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6061.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6061.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7377.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 6630.07, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 9850.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7026.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7026.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 12502.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 6819.5, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 6819.5, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7577.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4262.23 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 7577.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7026.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7026.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 7577.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 5682.92, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 59000, "minimum": 10350, "maximum": 103250.6125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 57230.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 103250.61, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 54831.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 46725.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 54178.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41300.25, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 57820.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 76700.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 76700.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 55756.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 68380.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 91450.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55230.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 55230.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 81530.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 94400.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 92051.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 47200.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47200.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 55230.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 51625.31, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 76700.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 97350.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 53100.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 53100.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62409.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 44250.26, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48367, "minimum": 25200, "maximum": 84643.615, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46916.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 84643.62, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 57568.33 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 49058.09 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 43177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 48367.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 44472.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 43177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 48367.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33857.45, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48367.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 47400.42, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 62878.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 62878.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 45767.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 56130.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 74970.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45336.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 45336.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 66924.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 77388.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 75560.28, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 48367.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48367.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 38694.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38694.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 45336.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 42321.81, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 62878.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 43177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 79806.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 43531, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 43531, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48367.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49535.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 48367.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 43177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43177.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 48367.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 36275.84, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42255, "minimum": 14850, "maximum": 73946.6525, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40987.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 73946.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 37760, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 42255.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37760, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 38892.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 37760, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 42255.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29578.66, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42255.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 41410.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 54931.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 54931.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 40025.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 49088, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 65495.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39648, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 39648, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 58528, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 67608.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 66080, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 42255.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42255.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 33804.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33804.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 39648, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 36973.33, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 54931.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 37760, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37760, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 69721.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 38029.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 38029.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42255.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50632.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 42255.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 37760, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37760, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 42255.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 31691.42, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29621, "minimum": 20734.763, "maximum": 51836.9075, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28732.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 51836.91, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 34129.06 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 29083.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 26562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 29621.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27359.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 26562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 29621.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20734.76, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29621.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 29028.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 38507.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 38507.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28156.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 34531.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 45912.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27890.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 27890.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41172.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 47393.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 46484.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 29621.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29621.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 23696.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23696.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 27890.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 25918.45, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 38507.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 26562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 48874.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 26658.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 26658.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29621.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29430.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 29621.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 26562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 29621.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 22215.82, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8158, "minimum": 5710.789, "maximum": 14276.9725, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7913.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14276.97, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7511.74 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6401.29 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7541.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8158.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7541.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7767.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7541.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8158.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5710.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8158.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 7995.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10605.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 10605.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7993.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 9803.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12645.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7918.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7918.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11688.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13053.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13197.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8158.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8158.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6526.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6526.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7918.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7138.49, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 10605.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7541.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7541.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13461.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7342.44, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7342.44, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8158.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7389.45 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8158.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7541.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7541.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8158.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6118.7, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Care Of Miscarriage", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13313.7, "discounted_cash": 3235, "minimum": 766.8691, "maximum": 13047.426, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2922.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2772.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "standard_charge_algorithm": "Not To Exceed $6000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 3108.82, "10th_percentile": 3108.82, "90th_percentile": 3493.7, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2265.16, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3171.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1889.92, "10th_percentile": 1237.79, "90th_percentile": 1889.92, "count": "1 through 10" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1185.95, "10th_percentile": 1185.95, "90th_percentile": 1185.95, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1944.96, "10th_percentile": 1944.96, "90th_percentile": 1944.96, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5662.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2831.45, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1063.52, "10th_percentile": 1063.52, "90th_percentile": 1118.82, "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": 5.76, "median_amount": 1834.86, "10th_percentile": 1834.86, "90th_percentile": 2159.32, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1744.17, "10th_percentile": 1744.17, "90th_percentile": 1744.17, "count": "1 through 10" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2426.96, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18910, "minimum": 13237.448, "maximum": 33093.62, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18343.32, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 33093.62, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21229.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 18090.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 18910.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17582.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 17070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18910.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13237.45, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18910.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 18532.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 24583.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 24583.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18094.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 22191.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29311.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17924.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17924.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26459.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 30257.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 29873.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 18910.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18910.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 15128.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15128.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 17924.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 16546.81, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 24583.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 17070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 31202.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 17019.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 17019.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18910.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26217 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18910.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 17070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18910.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14182.98, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16098, "minimum": 9000, "maximum": 28172.69, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15615.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28172.69, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17002.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14488.76 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14578.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16098.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14578.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15015.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14578.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16098.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11269.08, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16098.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15776.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20928.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 20928.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15453.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 18952.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24952.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15307.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15307.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22596.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 25757.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 25512.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16098.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16098.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12878.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12878.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15307.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14086.35, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 20928.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14578.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14578.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 26562.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14488.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14488.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16098.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21787.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16098.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14578.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14578.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16098.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12074.01, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35856, "minimum": 21150, "maximum": 62748.0175, "payers_information": [ { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 26892.01, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34780.33, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 62748.02, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 42373.21 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 36109.24 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 32088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 35856.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 33051.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 32088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 35856.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25099.21, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35856.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 35138.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 46612.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 46612.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 34013.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 41715.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 55576.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33693.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 33693.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49737.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 57369.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 56155.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 35856.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35856.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 28684.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28684.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 33693.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 31374.01, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 46612.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 32088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 59162.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 32270.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 32270.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35856.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40793.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 35856.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 32088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 35856.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30568, "minimum": 21397.873, "maximum": 55837.1, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29651.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 53494.68, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 38211.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 32562.46 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 27402.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 30568.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27402.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 28224.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 27402.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 30568.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21397.87, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30568.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 29957.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 39738.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 39738.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29046.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 35623.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 47381, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28772.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 28772.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42473.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 48909.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 47954.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 30568.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30568.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 24454.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24454.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 28772.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 26747.34, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 39738.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 27402.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27402.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 50437.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 27511.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 27511.55, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30568.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55837.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 30568.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 27402.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27402.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 30568.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 22926.29, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12063.1, "discounted_cash": 1952, "minimum": 694.8346, "maximum": 11821.838, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1893.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3904.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2011.64 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1908.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2235.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2235.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2010.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2928.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1366.41, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1912.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2732.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2537.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2069.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2537.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3025.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2049.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2049.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3416.02, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1561.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1561.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 2049.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1708.01, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2537.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3220.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2440.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1756.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1756.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1952.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1464.01, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16680, "minimum": 9000, "maximum": 29191.0325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16180.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29191.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18210.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15518.09 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15094.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16680.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15094.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15547.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15094.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16680.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11676.41, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16680.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16346.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21684.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21684.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15999.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19622.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25854.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15848.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15848.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23396.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 26688.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 26414.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16680.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16680.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13344.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13344.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15848.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14595.52, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21684.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15094.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15094.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27522.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15012.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15012.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16680.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15922.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16680.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15094.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15094.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16680.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12510.44, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 63750, "minimum": 37350, "maximum": 111563.48, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 61838.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 111563.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 56810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 63750.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 58514.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 56810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 63750.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 44625.39, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63750.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 62475.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 82875.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 82875.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 60219.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 73853.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 98813.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 59651.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 59651.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 88056.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 102000.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 99418.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 63750.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 63750.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 51000.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51000.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 59651.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 55781.74, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 82875.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 56810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 56810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 105188.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 57375.5, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 57375.5, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 63750.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61542.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 63750.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 56810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 63750.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 47812.92, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 59000, "minimum": 23400, "maximum": 103250.6125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 57230.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 103250.61, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 69219.74 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 58987.09 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 54178.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41300.25, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 57820.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 76700.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 76700.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 55756.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 68380.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 91450.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55230.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 55230.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 81530.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 94400.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 92051.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 47200.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47200.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 55230.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 51625.31, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 76700.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 97350.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 53100.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 53100.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49635.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52600.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 59000.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 44250.26, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 86448, "minimum": 48150, "maximum": 151284.3675, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 83854.76, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 151284.37, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 111195.3 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 94757.46 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 76926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 86448.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 76926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 79234.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 76926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 86448.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 60513.75, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 86448.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 84719.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 112382.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 112382.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 81542.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 100004.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 133994.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80772.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 80772.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 119236.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 138317.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 134621.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 86448.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 86448.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 69158.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 69158.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 80772.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 75642.18, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 112382.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 76926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 76926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 142639.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 77803.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 77803.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 86448.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 108469 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 86448.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 76926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 76926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 86448.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 64836.16, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16217, "minimum": 11352.341, "maximum": 28380.8525, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15731.1, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28380.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16030.95 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13661.11 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14683.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16217.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14683.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15124.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14683.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16217.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11352.34, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16217.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15893.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21082.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21082.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15564.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19089.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25137.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15418.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15418.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22760.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 25948.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 25696.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16217.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16217.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12974.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12974.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15418.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14190.43, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21082.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14683.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14683.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 26759.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14595.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14595.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16217.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15707.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16217.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14683.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14683.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16217.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12163.22, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10547, "minimum": 7383.25, "maximum": 18458.125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10231.08, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18458.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9258.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7889.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9658.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10547.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9658.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9948.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9658.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10547.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7383.25, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10547.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10336.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13711.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13711.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10238.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12556.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16348.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10141.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10141.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14970.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16876, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16902.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10547.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10547.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8438, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8438, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10141.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9229.06, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13711.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9658.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9658.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17403.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9492.75, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9492.75, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10547.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8376.09 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10547.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9658.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9658.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10547.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7910.63, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cardioversion Electric Ext", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11460.8, "discounted_cash": 660, "minimum": 165.2803, "maximum": 11231.584, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.88, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1321.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 627.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 595.47 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 697.4 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 697.4 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 680.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 991.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 462.49, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 647.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 924.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 858.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 858.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1024.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 693.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 693.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1024.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1156.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 528.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 528.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 693.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 578.11, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 858.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1090.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 825.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 594.63, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 594.63, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 495.53, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45863, "minimum": 13950, "maximum": 80261.8075, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 44487.97, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 80261.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 48532.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 41357.65 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 40958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 45863.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 42186.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 40958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 45863.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32104.72, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45863.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 44946.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 59623.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 59623.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 43415.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 53245.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 71089.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43006.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 43006.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 63485.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 73382.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 71676.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 45863.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 45863.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 36691.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36691.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 43006.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 40130.9, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 59623.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 40958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 75675.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 41277.5, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 41277.5, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45863.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41236.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 45863.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 40958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 45863.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 34397.92, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54133, "minimum": 27900, "maximum": 94734.08, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 70373.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 48287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 89320.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 48720.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 48720.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35605.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 54133.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 48287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 54133.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 40600.32, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 52509.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 94734.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 48287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 54133.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 49736.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 48287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 54133.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37893.63, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54133.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 53051.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 70373.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 70373.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 51184.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 62773.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 83907.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50701.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 50701.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 74845.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 86614.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 84503.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 54133.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 54133.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 43307.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43307.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 50701.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 47367.04, "additional_payer_notes": "87.50% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19358, "minimum": 5400, "maximum": 33876.85, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18777.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 33876.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19735.64 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16818.15 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17467.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 19358.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17467.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17991.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 17467.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19358.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13550.74, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19358.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 18971.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25165.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 25165.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18515.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 22707.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30005.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18340.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18340.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27074.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 30973.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 30567.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 19358.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19358.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 15486.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15486.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 18340.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 16938.43, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 25165.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 17467.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17467.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 31941.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 17422.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 17422.38, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19358.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21270.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19358.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 17467.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17467.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19358.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14518.65, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20036, "minimum": 10800, "maximum": 35064.4, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19435.7, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 35064.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22603.45 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 19262.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18068.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 20036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18068.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18610.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18068.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14025.76, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 19636.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26047.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 26047.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19152.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 23489.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31057.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18972.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18972.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28006.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 32058.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 31620.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 20036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16029.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16029.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 18972.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17532.2, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 26047.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18068.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18068.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 33060.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18033.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18033.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18438.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18068.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18068.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15027.6, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 68439, "minimum": 38250, "maximum": 119768.53, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 66385.99, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 119768.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 85875.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 73180.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 60965.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 68439.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 60965.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 62794.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 60965.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 68439.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47907.41, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68439.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 67070.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 88970.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 88970.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 64623.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 79255.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 106080.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 64014.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 64014.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 94496.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 109502.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 106690.15, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 68439.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 68439.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 54751.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 54751.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 64014.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 59884.27, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 88970.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 60965.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 60965.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 112924.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 61595.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 61595.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 68439.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71889.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 68439.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 60965.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 60965.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 68439.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 51329.37, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10185, "minimum": 5398.19, "maximum": 17824.66, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13241.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13241.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9898.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13950, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 18000, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12139.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15787.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9804.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9804.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14473.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16296.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16341.26, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10185.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10185.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8148.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8148.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9804.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8912.33, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13241.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9337.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9337.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16806.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9166.97, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9166.97, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10185.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5398.19 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10185.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9337.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9337.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10185.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7639.14, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9879.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17824.66, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9006.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7675.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9337.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10185.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9337.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9618, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9337.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10185.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7129.86, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10185.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9981.81, "additional_payer_notes": "98.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27943, "minimum": 11250, "maximum": 48901.72, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27105.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 48901.72, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 32550.17 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 27738.32 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 25076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 27943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 25828.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 25076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 27943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19560.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 27384.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 36326.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 36326.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26580.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 32599.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 43312.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26330.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 26330.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38868.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 44710.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 43883.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 27943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 22355.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22355.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 26330.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 24450.86, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 36326.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 25076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 46107.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 25149.46, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 25149.46, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26059.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 27943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 25076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 27943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 20957.88, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11804, "minimum": 7225, "maximum": 20658.015, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11450.44, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20658.02, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9596 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7225 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10772.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11804.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10772.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11095.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10772.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11804.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8263.21, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11804.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11568.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15345.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 15345.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11419.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14004.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11311.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11311.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16697.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 18852.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11804.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11804.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9443.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9443.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11311.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10329.01, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 15345.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10772.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10772.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 19477.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10624.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10624.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11804.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8679.45 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11804.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10772.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10772.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11804.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8853.44, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23189, "minimum": 8550, "maximum": 40581.345, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22493.66, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 40581.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24915.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 21232.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 20862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 23189.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 21488.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 20862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23189.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16232.54, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23189.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 22725.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 30146.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 30146.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22114.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 27121.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 35943.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21905.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 21905.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32337.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 37102.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 36509.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 23189.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23189.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 18551.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18551.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 21905.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 20290.67, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 30146.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 20862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 38262.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 20870.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 20870.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23189.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25980.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 23189.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 20862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23189.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 17392.01, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12289, "minimum": 7225, "maximum": 21507.115, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11921.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21507.12, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9596 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7225 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11202.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12289.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11202.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11538.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11202.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12289.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8602.85, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12289.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12043.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15976.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 15976.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11874.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 14850, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14563.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11762.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11762.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17364.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 19604.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12289.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12289.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9831.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9831.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11762.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10753.56, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 15976.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11202.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11202.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20278.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11060.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11060.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12289.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12847.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12289.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11202.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11202.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12289.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9217.34, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43845, "minimum": 30691.64, "maximum": 76729.1, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42529.84, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 76729.1, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 60759.17 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 51777.23 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 39169.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 43845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39169.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 40344.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 39169.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 43845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30691.64, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 42968.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 56998.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 56998.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 41519.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 50919.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 67960.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41127.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 41127.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 60712.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 70152.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 68545.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 43845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 35076.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35076.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 41127.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 38364.55, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 56998.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 39169.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39169.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 72344.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 39460.68, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 39460.68, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48083.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 43845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 39169.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39169.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 43845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 32883.9, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14895, "minimum": 10426.857, "maximum": 26067.1425, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14448.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26067.14, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15315.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13051.51 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14895.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13917.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14895.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10426.86, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14895.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14597.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19364.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 19364.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14322.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 17565.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23088.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14187.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14187.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20943.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 23832.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 23646.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14895.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14895.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11916.41, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11916.41, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14187.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13033.57, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 19364.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24577.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13405.96, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13405.96, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14895.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11994.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14895.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14895.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11171.63, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20595, "minimum": 14416.92, "maximum": 36042.3, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19977.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36042.3, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24081.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 20521.2 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18563.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 20595.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18563.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19120.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18563.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20595.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14416.92, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20595.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 20183.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26774.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 26774.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19677.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 24133.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31923.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19492.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19492.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28774.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 32952.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 32486.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 20595.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20595.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16476.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16476.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 19492.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18021.15, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 26774.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18563.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18563.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 33982.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18536.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18536.04, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20595.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14694.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20595.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18563.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18563.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20595.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15446.7, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15088, "minimum": 9719.96, "maximum": 26405.5925, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14636.24, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26405.59, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15845.44 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13503.04 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 15088.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14094.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15088.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10562.24, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15088.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14787.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19615.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 19615.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14504.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 17788.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23387.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14367.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14367.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21209.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 24142.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 23946.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 15088.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15088.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12071.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12071.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14367.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13202.8, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 19615.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24896.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13580.02, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13580.02, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15088.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9719.96 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15088.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15088.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11316.68, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13927, "minimum": 8540.53, "maximum": 24373.4225, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13509.84, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24373.42, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14234.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12130.29 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12654.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13927.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12654.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13034.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 12654.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13927.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9749.37, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13927.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 13649.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18105.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 18105.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13413.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16450.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21587.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13287.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13287.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19614.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 22284.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 22145.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13927.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13927.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11142.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11142.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13287.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12186.71, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 18105.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 12654.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12654.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 22980.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12534.9, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12534.9, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13927.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8540.53 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13927.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 12654.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12654.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13927.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10445.75, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16848, "minimum": 7225, "maximum": 29484.5425, "payers_information": [ { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12636.23, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16342.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29484.54, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9596 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7225 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16848.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15700.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16848.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11793.82, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16848.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16511.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21902.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21902.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16157.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 18900, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19815.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16004.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16004.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23626.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 26674.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16848.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16848.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13478.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13478.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 16004.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14742.27, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21902.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27799.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15163.48, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15163.48, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16848.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16848.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16848.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10937, "minimum": 7225, "maximum": 19141.01, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10609.59, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19141.01, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9596 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7225 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10004.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10937.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10004.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10304.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10004.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10937.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7656.4, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10937.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10718.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14219.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14219.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10604.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 9000, "90th_percentile": 22500, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13005.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10504.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10504.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15506.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 17507.88, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10937.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10937.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8750.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8750.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10504.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9570.51, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14219.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10004.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10004.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18047.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9843.95, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9843.95, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10937.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9389.19 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10937.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10004.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10004.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10937.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8203.29, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23742, "minimum": 7225, "maximum": 41548.7625, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23029.89, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41548.76, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9596 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7225 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21352.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 23742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21352.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 21993.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 21352.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16619.51, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 23267.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 30864.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 30864.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22633.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 27758.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22420.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 22420.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33096.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 37367.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 23742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 18993.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18993.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 22420.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 20774.38, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 30864.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 21352.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21352.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 39174.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 21367.94, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 21367.94, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13756.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 23742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 21352.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21352.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23742.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 17806.61, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24917, "minimum": 14737.3, "maximum": 43606.395, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24170.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 43606.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28463.8 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 24256.04 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 22394.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 24917.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22394.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 23066.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 22394.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 24917.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17442.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24917.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 24419.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 32393.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 32393.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23738.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 29112.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 38622.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23514.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 23514.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34711.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 39868.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 39190.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 24917.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24917.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 19934.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19934.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 23514.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 21803.2, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 32393.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 22394.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22394.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 41114.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 22426.15, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 22426.15, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24917.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14737.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 24917.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 22394.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22394.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 24917.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 18688.46, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10929, "minimum": 7201.38, "maximum": 19126.03, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10601.29, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19126.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9596 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7225 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9996.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10929.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9996.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10296.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9996.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10929.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7650.41, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10929.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10710.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14207.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14207.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10596.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12996, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8500, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10496.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10496.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15495.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.61, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10929.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10929.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8743.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8743.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10496.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9563.02, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14207.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9996.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18033.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9836.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9836.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7201.38 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10929.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9996.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9996.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10929.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8196.87, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 372265, "minimum": 55350, "maximum": 651464.3975, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 361097.41, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 651464.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 397964.47 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 339133.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 330235, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 372265.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 330235, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 340142.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 330235, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 372265.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 260585.76, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 372265.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 364820.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 483944.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 483944.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 350049.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 429305.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 577011.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 346746.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 346746.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 511864.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 595624.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 577911.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 372265.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 372265.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 297812.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 297812.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 346746.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 325732.2, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 483944.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 330235, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 330235, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 614237.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 335038.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 335038.83, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 372265.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 343269 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 372265.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 330235, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 330235, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 372265.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 279199.03, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8894, "minimum": 6193.94, "maximum": 15564.8675, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8627.38, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15564.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7684.45 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6548.47 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8193.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8894.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8193.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8439.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8193.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8894.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6225.95, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8894.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8716.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11562.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11562.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10651.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13786.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8603.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8603.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12699.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 14230.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14338.49, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8894.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8894.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7115.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7115.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8603.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7782.43, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11562.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8193.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14675.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8004.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8004.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8894.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6193.94 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8894.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8193.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8193.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8894.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6670.66, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20724, "minimum": 14507.367, "maximum": 36268.4175, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20103.07, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36268.42, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24261.24 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 20674.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18678.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 20724.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18678.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19238.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18678.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20724.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14507.37, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20724.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 20310.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26942.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 26942.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19799.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 24281.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32123.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19612.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19612.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28951.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 33159.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 32687.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 20724.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20724.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16579.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16579.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 19612.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18134.21, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 26942.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18678.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18678.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 34195.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18652.33, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18652.33, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20724.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22361.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20724.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18678.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18678.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20724.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15543.61, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16942, "minimum": 11859.708, "maximum": 29649.27, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16434.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29649.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18458.46 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15729.77 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15326.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16942.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15326.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15786.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15326.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16942.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11859.71, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16942.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16603.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22025.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 22025.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16245.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19924.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26260.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16092.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16092.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23755.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 27107.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 26821.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16942.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16942.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13553.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13553.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 16092.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14824.64, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 22025.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15326.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15326.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27955.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15248.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15248.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16942.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17440.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16942.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15326.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15326.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16942.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12706.83, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33219, "minimum": 23253.629, "maximum": 58134.0725, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32222.89, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 58134.07, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 38651.46 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 32937.67 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 29752, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 33219.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29752, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 30644.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 29752, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 33219.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23253.63, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33219.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 32555.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 43185.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 43185.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 31537.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 38677.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 51490.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31239.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 31239.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46115.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 53151.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 52066, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 33219.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33219.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 26575.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26575.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 31239.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 29067.04, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 43185.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 29752, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29752, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 54812.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 29897.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 29897.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33219.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36755.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 33219.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 29752, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29752, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 33219.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 24914.6, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20418, "minimum": 14292.922, "maximum": 35732.305, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19805.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 35732.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21662.09 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 18459.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 20418.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18959.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20418.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14292.92, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20418.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 20010.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26544, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 26544, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19511.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 23928.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31648.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19327.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19327.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28530.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 32669.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 32212.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 20418.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20418.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16334.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16334.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 19327.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17866.15, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 26544, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 33690.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18376.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18376.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20418.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21218.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20418.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20418.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15313.85, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14399, "minimum": 10079.426, "maximum": 25198.565, "payers_information": [ { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12599.28, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 18718.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13072.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13072.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 23758.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12959.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12959.26, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14399.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21471.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14399.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13072.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13072.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14399.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10799.39, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13967.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25198.57, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15162.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12920.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13072.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14399.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13072.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13464.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13072.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14399.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10079.43, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14399.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14111.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18718.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 18718.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13856.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16993.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22318.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13725.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13725.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20262.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 23038.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 22876.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14399.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14399.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11519.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11519.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13725.92, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Circum 28 Days Or Older", "code_information": [ { "code": "54161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14870.2, "discounted_cash": 2089, "minimum": 856.5235, "maximum": 14572.796, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2026.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4179.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2072.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1966.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3134.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1462.73, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2047.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2925.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2214.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1828.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3447.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2612.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1567.21, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9946, "minimum": 6962.739, "maximum": 17406.8475, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9648.37, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17406.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9414.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8022.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9126.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9946.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9126.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9400.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9126.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9946.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6962.74, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9946.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9747.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12930.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12930.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9673.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11864.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15417.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9582.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9582.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14145.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15914.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15970.97, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9946.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9946.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7957.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7957.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9582.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8703.42, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12930.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9126.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9126.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16412.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8952.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8952.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9946.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7592.63 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9946.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9126.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9126.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9946.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7460.08, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8830, "minimum": 5629.07, "maximum": 15452.5525, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8565.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15452.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6605.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5629.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8136.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8830.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8136.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8380.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8136.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8830.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6181.02, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8830.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8653.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11479.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11479.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8624.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10577.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13686.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8543.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8543.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12611.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 14128.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14238.95, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8830.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8830.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7064.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7064.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8543.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7726.28, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11479.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8136.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8136.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14569.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7947.03, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7947.03, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8830.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6282.77 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8830.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8136.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8136.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8830.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6622.52, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12211, "minimum": 8533.91, "maximum": 21370.8425, "payers_information": [ { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8548.34, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12211.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11967.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15875.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 15875.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11801.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 15300, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 27000, "10th_percentile": 27000, "90th_percentile": 27000, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14473.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18928.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11690.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11690.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17257.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 19539.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 19484.15, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12211.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12211.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9769.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9769.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11690.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10685.42, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 15875.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20149.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10990.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10990.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12211.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8533.91 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12211.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12211.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9158.93, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11845.55, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21370.84, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11981.9 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10210.63 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12211.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11467.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12211.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8226, "minimum": 4731.93, "maximum": 14396.7775, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7979.93, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14396.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7408.33 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6313.17 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7601.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8226.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7601.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7829.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7601.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8226.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5758.71, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8226.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8062.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10694.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 10694.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 9882.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12751.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7981.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7981.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11782.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13162.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13303.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8226.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8226.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6581.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6581.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7981.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7198.39, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 10694.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7601.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7601.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13574.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7404.06, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7404.06, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8226.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4731.93 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8226.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7601.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7601.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8226.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6170.05, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44054, "minimum": 30837.8, "maximum": 77094.5, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42732.38, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 77094.5, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 53484.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 45577.63 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 39354.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 44054, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39354.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 40534.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 39354.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 44054, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30837.8, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44054, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 43172.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 57270.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 57270.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 41715.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 51160.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 68283.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41321.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 41321.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 60999.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 70486.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 68869.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 44054, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 44054, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 35243.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35243.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 41321.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 38547.25, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 57270.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 39354.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 72689.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 39648.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 39648.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44054, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41631.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 44054, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 39354.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39354.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 44054, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 33040.5, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19575, "minimum": 13702.885, "maximum": 34257.2125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18988.28, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 34257.21, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20065.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 17098.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17659.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 19575.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17659.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18189.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 17659.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19575.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13702.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19575.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 19184.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25448.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 25448.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18719.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 22957.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30342.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18542.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18542.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27372.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 31320.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 30904.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 19575.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19575.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 15660.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15660.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 18542.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17128.61, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 25448.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 17659.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17659.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 32299.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 17618, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 17618, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19575.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18721.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19575.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 17659.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17659.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19575.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14681.66, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23624, "minimum": 7200, "maximum": 41342.105, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22915.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41342.11, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 27081.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 23077.72 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21247.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 23624.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21247.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 21885.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 21247.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23624.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16536.84, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23624.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 23151.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 30711.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 30711.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22522.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 27622.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36617.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22310.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 22310.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32934.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 37798.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 37183.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 23624.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23624.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 18899.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18899.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 22310.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 20671.05, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 30711.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 21247.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21247.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 38979.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 21261.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 21261.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23624.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22265.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 23624.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 21247.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21247.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23624.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 17718.05, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11890, "minimum": 8323.105, "maximum": 20807.7625, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11533.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20807.76, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12260.15 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10447.75 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10848.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11890.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10848.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11174.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10848.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11890.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8323.11, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11890.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11652.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15457.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 15457.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11499.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9450, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14103.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18429.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11391.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11391.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16815.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 19024.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 18985.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11890.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11890.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9512.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9512.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11391.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10403.88, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 15457.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10848.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10848.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 19618.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10701.14, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10701.14, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11890.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11455.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11890.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10848.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10848.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11890.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8917.61, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cltx Dst Rdl Fx/Ephys Sep W/", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 1607, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1559.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3214.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1585.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1504.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1762.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1762.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1655.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1125.17, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1575.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2250.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1703.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2812.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1285.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1285.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1406.47, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2009.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1446.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1446.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1205.54, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cmbn Ant Pst Colprhy", "code_information": [ { "code": "57260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23267.5, "discounted_cash": 5000, "minimum": 1340.208, "maximum": 22802.15, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4850.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10001.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4997.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4741.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5553 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5553 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "standard_charge_algorithm": "Not To Exceed $6000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6000, "10th_percentile": 6000, "90th_percentile": 6000, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5150.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7500.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3500.43, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 4900.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7000.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5300.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8751.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4000.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4000.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4375.54, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8251.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6250.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 4500.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 4500.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 3750.47, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10001, "minimum": 6887.62, "maximum": 17502.695, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9701.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17502.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10970.17 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9348.47 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10001.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9450.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10001.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7001.08, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10001.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9801.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13002, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13002, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9725.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11927.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15502.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9633.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9633.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14220.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16002.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16055.92, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10001.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10001.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8001.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8001.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9633.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8751.35, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13002, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16502.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9001.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9001.39, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10001.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6887.62 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10001.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10001.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7501.16, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cltx Sho Dslc W/Mnpj W/Anes", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 1607, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1559.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3214.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1585.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1504.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1762.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1762.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1655.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1125.17, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1575.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2250.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1703.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2812.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1285.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1285.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1406.47, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2009.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1446.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1446.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1205.54, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cltx Sho Dslc W/Mnpj Wo Anes", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 246, "minimum": 25, "maximum": 12325.46, "payers_information": [ { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 308.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 221.92, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 221.92, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 184.94, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 239.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 493.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 252.3 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 239.36 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 280.33 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 280.33 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 253.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 369.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 172.61, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 241.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 345.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 258.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 431.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 197.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 197.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 258.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 215.76, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 246.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31000, "minimum": 21700.378, "maximum": 54250.945, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30070.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 54250.95, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 40004.34 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 34090.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 27785.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 31000.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27785.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 28618.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 27785.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 31000.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21700.38, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31000.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 30380.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 40300.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 40300.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29452.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 36121.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 48050.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29174.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 29174.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43067.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 49600.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 48624.45, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 31000.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31000.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 24800.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24800.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 29174.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 27125.47, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 40300.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 27785.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27785.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 51150.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 27900.49, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 27900.49, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31000.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28705.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 31000.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 27785.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27785.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 31000.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 23250.41, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC", "code_information": [ { "code": "454", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 55401.24, "maximum": 72231.9945, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 65011.84 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 55401.24 } ] } ] }, { "description": "COLPOPEXY EXTRAPERITONEAL", "code_information": [ { "code": "57282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12409.96, "discounted_cash": 7412, "minimum": 714.8137, "maximum": 12409.96, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7190.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 12409.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7843.21 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7441 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8714.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8714.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "standard_charge_algorithm": "Not To Exceed $6000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 3341.98, "10th_percentile": 3341.98, "90th_percentile": 3341.98, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7635.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 11119.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5188.9, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 7264.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10377.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9636.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7857.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9636.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11489.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7783.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7783.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11489.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12409.96, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 5930.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5930.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 7783.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 6486.13, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 9636.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 12230.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 9265.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 6671.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 6671.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 5559.54, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9583, "minimum": 5603.27, "maximum": 16771.8775, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9296.41, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16771.88, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8190.85 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6980.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8804.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9583.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8804.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9068.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8804.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9583.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6708.75, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9583.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9392.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12459.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12459.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9332.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11446.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14855.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9244.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9244.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13647.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15334.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15408.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9583.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9583.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7667.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7667.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9244.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8385.94, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12459.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8804.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8804.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15813.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8625.54, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8625.54, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5603.27 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9583.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8804.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8804.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9583.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7187.95, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC", "code_information": [ { "code": "453", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 83523.86, "maximum": 108898.192, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 98012.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 83523.86 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12004, "minimum": 8403.374, "maximum": 21008.435, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11644.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21008.44, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11297.46 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9627.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12004.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11278.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12004.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8403.37, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12004.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11764.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15606.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 15606.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11607.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14235.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18607.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11497.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16972.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 19207.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 19162.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12004.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12004.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9603.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9603.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11497.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10504.22, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 15606.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 19807.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10804.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10804.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12004.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9488.43 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12004.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12004.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9003.62, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14300, "minimum": 10010.539, "maximum": 25026.3475, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13871.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25026.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15557.6 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13257.74 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14300.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13374.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 12985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14300.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10010.54, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14300.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14014.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18591, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 18591, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13764.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16880.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22166.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13634.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13634.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20126.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 22881.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 22723.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14300.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14300.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11440.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11440.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13634.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12513.17, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 18591, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 12985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 23596.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12870.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12870.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14300.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14798.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14300.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 12985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14300.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10725.58, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19524, "minimum": 13666.947, "maximum": 34167.3675, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18938.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 34167.37, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20075.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 17107.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17614.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 19524.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17614.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18142.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 17614.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19524.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13666.95, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19524.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 19133.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25381.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 25381.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18671.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 22898.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30262.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18495.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18495.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27302.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 31238.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 30825.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 19524.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19524.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 15619.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15619.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 18495.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17083.68, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 25381.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 17614.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17614.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 32214.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 17571.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 17571.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19524.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14147.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19524.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 17614.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17614.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19524.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14643.16, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 95786, "minimum": 56250, "maximum": 167627.075, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 92913.29, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 167627.08, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 85203, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 95786.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 85203, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 87759.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 85203, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 95786.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 67050.83, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 95786.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 93871.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 124522.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 124522.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 90315.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 110763.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 148469.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 89463.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 89463.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 132064.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 153259.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 149105.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 95786.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 95786.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 76629.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 76629.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 89463.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 83813.54, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 124522.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 85203, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 85203, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 158048.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 86208.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 86208.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 95786.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 114279 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 95786.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 85203, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 85203, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 95786.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 71840.18, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8623, "minimum": 5680.77, "maximum": 15091.6325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8365.08, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15091.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7371.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6281.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7953.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8623.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7953.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8192.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7953.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8623.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6036.65, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8623.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8451.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11210.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11210.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8431, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10339.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13366.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8351.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8351.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12328.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13798.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13919.1, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8623.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8623.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6899.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6899.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8351.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7545.82, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11210.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7953.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7953.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14229.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7761.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7761.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8623.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5680.77 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8623.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7953.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7953.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8623.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6467.84, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12134, "minimum": 8493.828, "maximum": 21234.57, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11770.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21234.57, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11313.45 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9641 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11064.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12134.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11064.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11396.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11064.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12134.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8493.83, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12134.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11891.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15774.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 15774.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11728.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14384.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18807.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11618.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11618.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17150.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 19414.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 19363.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12134.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12134.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9707.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9707.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11618.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10617.29, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 15774.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11064.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11064.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20021.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10920.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10920.64, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12134.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14376.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12134.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11064.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11064.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12134.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9100.53, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21668, "minimum": 15168.083, "maximum": 37920.2075, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21018.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 37920.21, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23604.52 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 20115.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 21668.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20100.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 19515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21668.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15168.08, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21668.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 21235.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 28169.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 28169.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20685.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 25369.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33586.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20490.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20490.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30248.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 34669.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 34151.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 21668.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21668.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 17334.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17334.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 20490.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18960.1, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 28169.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 19515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 35753.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 19501.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 19501.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21668.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19264.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21668.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 19515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21668.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 16251.52, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Conization Of Cervix - 57522 - OR36057522", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12930.6, "discounted_cash": 3235, "minimum": 744.8026, "maximum": 12671.988, "payers_information": [ { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 2288.88, "10th_percentile": 2288.88, "90th_percentile": 2288.88, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5662.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2831.45, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2426.96, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2922.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2772.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2265.16, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3171.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11771, "minimum": 8239.847, "maximum": 20599.6175, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11418.07, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20599.62, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10964.84 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9343.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10743.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11771.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10743.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11065.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10743.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11771.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8239.85, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11771.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11535.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15302.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 15302.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11387.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13966.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18245.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11280.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11280.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16651.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 18833.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 18800.6, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11771.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11771.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9416.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9416.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11280.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10299.81, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 15302.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10743.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10743.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 19422.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10594.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10594.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9538.52 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11771.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10743.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10743.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11771.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8828.41, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12602, "minimum": 8822.093, "maximum": 22055.2325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12224.9, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22055.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12863.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10961.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11480.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12602.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11480.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11824.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11480.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12602.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8822.09, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12602.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12350.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16383.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16383.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12169.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14924.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19534.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12054.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17794.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20164.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20090.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12602.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12602.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10082.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10082.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12054.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11027.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16383.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11480.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11480.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20794.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11342.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11342.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12602.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11877.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12602.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11480.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11480.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12602.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9452.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23969, "minimum": 16778.846, "maximum": 41947.115, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23969.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22907.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 23969.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 21554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23969.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 17977.34, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23250.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41947.12, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26647.17 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 22707.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 23969.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22200.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 21554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23969.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16778.85, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23969.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 23490.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 31160.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 31160.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22847.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 28020.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37153.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22632.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 22632.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33409.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 38351.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 37720.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 23969.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23969.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 19175.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19175.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 22632.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 20973.56, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 31160.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 21554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 39550.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 21572.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 21572.8, "additional_payer_notes": "90.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9888, "minimum": 6922.006, "maximum": 17305.015, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9591.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17305.02, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8880.61 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7567.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9888.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9346.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9888.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6922.01, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9888.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9690.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12855.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12855.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9619.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11797.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15327.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9528.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9528.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14065.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15821.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9888.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9888.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7910.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7910.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9528.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8652.51, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12855.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16316.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8899.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8899.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9888.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7637.05 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9888.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9888.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7416.44, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Double Osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44019.5, "discounted_cash": 7253, "minimum": 1500, "maximum": 43139.11, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7035.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 14507.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6998.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6639.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7776.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7776.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7471.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 10880.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5077.49, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 7108.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10154.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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": 11243.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12693.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 5802.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5802.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 6346.87, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 6528.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 6528.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 5440.17, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs dstl mtar osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21223.68, "discounted_cash": 3270, "minimum": 1222.484, "maximum": 20799.2064, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3202.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3038.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2289.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5723.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2861.95, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2453.1, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49479, "minimum": 34635.573, "maximum": 86588.9325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47995.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 86588.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 56688.8 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 48308.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 44162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 49479.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 45487.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 44162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 49479.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34635.57, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49479.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 48489.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 64323.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 64323.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 46812.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 57411.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 76693.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46370.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 46370.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 68451.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 79167.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 77284.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 49479.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49479.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 39583.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39583.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 46370.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 43294.47, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 64323.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 44162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 81640.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 44531.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 44531.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49479.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60828.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 49479.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 44162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 49479.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 37109.54, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Rsc Prx Phlx Bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31442.5, "discounted_cash": 3270, "minimum": 1500, "maximum": 30813.65, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3202.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3038.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2289.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5723.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2861.95, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2453.1, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52952, "minimum": 36450, "maximum": 92667.47, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51364.25, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 92667.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 64287.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 54784.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 47240.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 52952.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47240.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 48658.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 47240.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 52952.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37066.99, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52952.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 51893.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 68838.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 68838.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 50075.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 61413.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 82076.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49602.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 49602.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 73223.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 84724.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 82671.58, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 52952.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 52952.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 42362.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42362.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 49602.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 46333.74, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 68838.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 47240.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47240.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 87372.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 47657.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 47657.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52952.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57151.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 52952.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 47240.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47240.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 52952.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 39714.63, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 68155, "minimum": 47709.137, "maximum": 119272.8425, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 66111.23, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 119272.84, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 83077.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 70796.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 60714.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 68155.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 60714.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 62536.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 60714.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 68155.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47709.14, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68155.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 66792.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 88602.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 88602.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 64357.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 78929.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 105641.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 63750.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 63750.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 94107.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 109049.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 106250.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 68155.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 68155.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 54524.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 54524.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 63750.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 59636.42, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 88602.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 60714.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 60714.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 112457.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 61340.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 61340.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 68155.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 74163.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 68155.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 60714.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 60714.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 68155.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 51116.93, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 74870, "minimum": 48600, "maximum": 131024.0925, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 72624.78, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 131024.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 90514.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77133.47 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 66666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 74870.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 66666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 68665.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 66666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 74870.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 52409.64, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 74870.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 73373.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 97332.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 97332.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 70665.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 86665.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 116049.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 69999.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 69999.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 103332.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 119793.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 116665.5, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 74870.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 74870.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 59896.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 59896.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 69999.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 65512.05, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 97332.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 66666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 66666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 123537, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 67383.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 67383.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 74870.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55988.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 74870.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 66666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 66666, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 74870.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 56153.18, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54612, "minimum": 34200, "maximum": 95572.6975, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 52974.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 95572.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 62881.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 53586.06 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 48712.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 54612.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48712.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 50173.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 48712.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 54612.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38229.08, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54612.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 53520.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 70996.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 70996.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 51634.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 63325.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 84650.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51147.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 51147.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 75503.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 87380.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 85246.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 54612.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 54612.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 43690.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43690.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 51147.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 47786.35, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 70996.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 48712.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48712.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 90111.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 49151.67, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 49151.67, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54612.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64081.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 54612.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 48712.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48712.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 54612.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 40959.73, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39764, "minimum": 20700, "maximum": 69587.2975, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38571.24, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 69587.3, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 35552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 39764.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 36618.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 35552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 39764.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27834.92, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39764.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 38968.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 51693.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 51693.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 37685.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 46217.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 61634.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37329.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 37329.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 55106.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 63622.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 62216.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 39764.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39764.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 31811.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31811.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 37329.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 34793.65, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 51693.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 35552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 65610.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 35787.75, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 35787.75, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39764.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49984.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 39764.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 35552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 39764.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 29823.13, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11553, "minimum": 8087.695, "maximum": 20219.2375, "payers_information": [ { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 18486.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 18463.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11553.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11553.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9243.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9243.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11078.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10109.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 15020.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10550.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10550.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 19063.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10398.47, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10398.47, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11553.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8855.23 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11553.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10550.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10550.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11553.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8665.39, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11207.23, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20219.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10857.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9252.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10550.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11553.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10550.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10867.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10550.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11553.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8087.7, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11553.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11322.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15020.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 15020.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11183.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13715.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17908.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11078.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11078.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16353.43, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15785, "minimum": 11049.836, "maximum": 27624.59, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15311.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27624.59, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16468.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14033.6 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 15785.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14729.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15785.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11049.84, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15785.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15469.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20521.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 20521.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15158.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 18591.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24467.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15015.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15015.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22166.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 25256.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 25026.58, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 15785.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15785.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12628.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12628.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15015.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13812.3, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 20521.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 26046.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14206.93, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14206.93, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15785.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11823.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15785.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15785.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11839.11, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29697, "minimum": 10350, "maximum": 51970.1875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28806.33, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 51970.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 26630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 29697.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27429.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 26630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 29697.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20788.08, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29697.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 29103.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 38606.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 38606.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28228.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 34619.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 46030.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27961.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 27961.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41276.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 47515.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 46603.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 29697.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29697.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 23757.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23757.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 27961.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 25985.09, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 38606.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 26630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 49000.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 26727.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 26727.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29697.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37677.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 29697.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 26630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 29697.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 22272.94, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29339, "minimum": 13500, "maximum": 51344.2125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28459.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 51344.21, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 32601.34 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 27781.93 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 26313.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 29339.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26313.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27102.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 26313.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 29339.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20537.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29339.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 28752.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 38141.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 38141.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27892.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 34207.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 45476.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27628.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 27628.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40785.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 46943.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 46048.28, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 29339.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29339.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 23471.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23471.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 27628.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 25672.11, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 38141.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 26313.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26313.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 48410.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 26405.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 26405.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29339.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26841.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 29339.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 26313.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26313.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 29339.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 22004.66, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30205, "minimum": 12150, "maximum": 52859.73, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29299.39, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 52859.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 27080.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 30205.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27080.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27893.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 27080.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 30205.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21143.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30205.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 29601.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 39267.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 39267.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28705.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 35205.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 46818.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28434.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 28434.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41975.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 48328.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 47391.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 30205.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30205.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 24164.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24164.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 28434.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 26429.87, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 39267.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 27080.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27080.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 49839.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 27185, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 27185, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30205.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30023.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 30205.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 27080.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27080.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 30205.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 22654.17, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24322, "minimum": 7200, "maximum": 42564.095, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23592.67, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 42564.1, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26778.3 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 22819.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 24322.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22522.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 21866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 24322.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17025.64, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24322.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 23835.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 31619.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 31619.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23178.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 28426.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37699.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22960.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 22960.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33893.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 38915.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 38266.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 24322.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24322.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 19457.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19457.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 22960.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 21282.05, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 31619.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 21866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 40131.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 21890.11, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 21890.11, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24322.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26797.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 24322.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 21866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 24322.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 18241.76, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "COLPOPEXY INTRAPERITONEAL", "code_information": [ { "code": "57283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25154, "discounted_cash": 7412, "minimum": 1448.8704, "maximum": 24650.92, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7190.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 14825.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7843.21 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7441 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8714.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8714.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7635.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 11119.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5188.9, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 7264.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10377.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9636.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7857.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9636.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11489.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7783.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7783.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11489.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12972.26, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 5930.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5930.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 7783.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 6486.13, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 9636.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 12230.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 9265.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 6671.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 6671.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7412.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 5559.54, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60333, "minimum": 39600, "maximum": 105583.8, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 58523.59, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 105583.8, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 67036.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 57126.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 53782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 60333.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 55395.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 53782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 60333.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42233.52, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60333.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 59126.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 78433.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 78433.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 57009.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 69916.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 93517.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56471.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 56471.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 83362.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 96533.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 94118.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 60333.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 60333.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 48266.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48266.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 56471.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 52791.9, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 78433.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 53782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 53782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 99550.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 54300.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 54300.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60333.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 94599.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 60333.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 53782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 60333.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 45250.2, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "455", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 43526.24, "maximum": 56749.395, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 51076.85 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 43526.24 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16461, "minimum": 11523.064, "maximum": 28807.66, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15967.67, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28807.66, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15452.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13167.8 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14900, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16461.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14900, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15347, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14900, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16461.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11523.06, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16461.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16132.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21399.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21399.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15794, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19370, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25515.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15645, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15645, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23095, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 26338.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 26075, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16461.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16461.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13169.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13169.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15645, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14403.83, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21399.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14900, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14900, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27161.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14815.37, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14815.37, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16461.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14221.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16461.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14900, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14900, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16461.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12346.14, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11309, "minimum": 7805.27, "maximum": 19792.43, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10970.66, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19792.43, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10952.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9333.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10334.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11309.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10334.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10644.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10334.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11309.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7916.97, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11309.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11083.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14702.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14702.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10954.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13434.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17530.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10851.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10851.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16018.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 18095.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 18085.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11309.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11309.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9047.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9047.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10851.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9896.22, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14702.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10334.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10334.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18661.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10178.96, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10178.96, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11309.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7805.27 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11309.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10334.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10334.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11309.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8482.47, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41640, "minimum": 29148.567, "maximum": 72871.4175, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40391.59, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 72871.42, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 47886.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 40807.09 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 37215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 41640.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 38331.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 37215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 41640.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29148.57, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41640.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 40807.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 54133.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 54133.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 39448.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 48380.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 64543.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39076.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 39076.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 57684.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 66625.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 65127.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 41640.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41640.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 33312.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33312.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 39076.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 36435.71, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 54133.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 37215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 68707.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 37476.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 37476.73, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41640.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40376.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 41640.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 37215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 41640.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 31230.61, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18399, "minimum": 12879.839, "maximum": 32199.5975, "payers_information": [ { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18399.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 18031.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 23919.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 23919.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17614.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 21603.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28519.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17448.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17448.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25757.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 29439.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 29081.15, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 18399.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18399.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 14719.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14719.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 17448.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 16099.8, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 23919.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 16617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 30359.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 16559.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 16559.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18399.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13475.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18399.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 16617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18399.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 13799.83, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17847.78, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32199.6, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19556.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16665.52 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 18399.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17116.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 16617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18399.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12879.84, "additional_payer_notes": "70.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51769, "minimum": 32850, "maximum": 90596.3625, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 50216.27, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 90596.36, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 60365.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 51442 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 46192, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 51769.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46192, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 47577.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 46192, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 51769.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36238.55, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51769.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 50733.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 67300.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 67300.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 48963.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 60049.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 80242.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48501.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 48501.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 71597.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 82830.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 80836, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 51769.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51769.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 41415.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41415.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 48501.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 45298.18, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 67300.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 46192, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 46192, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 85419.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 46592.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 46592.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51769.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59817.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 51769.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 46192, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 46192, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 51769.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 38827.01, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9777, "minimum": 6844.131, "maximum": 17110.3275, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9484.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17110.33, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9113.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7765.86 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8976.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8976.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9245.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8976.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6844.13, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9581.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12710.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12710.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9514.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11668.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15154.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9424.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9424.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15643.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15708.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7821.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7821.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9424.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8555.16, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12710.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8976.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8976.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16132.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8799.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8799.6, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11777.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8976.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8976.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7333, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52214 - OR36052214", "code_information": [ { "code": "52214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28298.3, "discounted_cash": 3523, "minimum": 1500, "maximum": 27732.334, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3417.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7047.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2072.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1966.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3629.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5285.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2466.58, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3453.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4933.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3735.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6166.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3083.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5814.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4404.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2642.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Conization Of Cervix - 57520 - OR36057520", "code_information": [ { "code": "57520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11945.1, "discounted_cash": 3235, "minimum": 688.0378, "maximum": 11706.198, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2922.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2772.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2265.16, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3171.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 2224.11, "10th_percentile": 2224.11, "90th_percentile": 2224.11, "count": "1 through 10" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5662.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2831.45, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "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": 5.76, "median_amount": 1834.86, "10th_percentile": 1834.86, "90th_percentile": 2159.32, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2426.96, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero W/Congen Repr", "code_information": [ { "code": "52400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 3523, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3417.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7047.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3350.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3629.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5285.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2466.58, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3453.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4933.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3735.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6166.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3083.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5814.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4404.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2642.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18865.5, "discounted_cash": 697, "minimum": 487.928, "maximum": 18488.19, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 723.49 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 717.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1045.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 487.93, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 683.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 975.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1080.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 731.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1080.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1219.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 557.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 557.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 731.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 609.91, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 906.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1150.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 871.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 627.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 627.34, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 522.78, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 676.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1394.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 651.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 617.75 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 697.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 723.49 } ] } ] }, { "description": "Cystoscopy And Treatment - 52234 - OR36052234", "code_information": [ { "code": "52234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22009.8, "discounted_cash": 3523, "minimum": 1267.7645, "maximum": 21569.604, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3417.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7047.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3350.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3629.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5285.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2466.58, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3453.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4933.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3735.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6166.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3083.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5814.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4404.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2642.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52235 - OR36052235", "code_information": [ { "code": "52235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28298.3, "discounted_cash": 3523, "minimum": 1500, "maximum": 27732.334, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3417.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7047.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3350.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3629.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5285.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2466.58, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3453.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4933.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3735.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6166.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3083.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5814.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4404.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2642.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Jt Arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40875.3, "discounted_cash": 12833, "minimum": 1500, "maximum": 40057.794, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12448.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25667.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6998.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6639.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7776.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7776.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13219, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 19250.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8983.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 12577.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17967.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22459.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 11229.73, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 16042.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 9625.49, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12466, "minimum": 4111.02, "maximum": 21817.11, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12092.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21817.11, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12478.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10633.99 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11359.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12466.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11359.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11700.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11359.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12466.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8726.84, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12466.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12217.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16207, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16207, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12041.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14767.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19323.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11927.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11927.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 19947.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 19879.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12466.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12466.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9973.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9973.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11927.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10908.56, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16207, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11359.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11359.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 20570.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11220.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11220.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12466.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4111.02 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12466.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11359.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11359.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12466.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9350.19, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 2089, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2026.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4179.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2072.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1966.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3134.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1462.73, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2047.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2925.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2214.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1828.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 686.75, "10th_percentile": 686.75, "90th_percentile": 686.75, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3447.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2612.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1567.21, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52276 - OR36052276", "code_information": [ { "code": "52276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15721.3, "discounted_cash": 2089, "minimum": 905.5469, "maximum": 15406.874, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2026.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4179.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2072.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1966.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3134.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1462.73, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2047.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2925.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2214.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1828.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3447.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2612.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1567.21, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOURETERO WSTONE REMOVE", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4380.99, "discounted_cash": 3523, "minimum": 252.345, "maximum": 4380.99, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3417.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3350.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3629.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2466.58, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3453.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3735.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3083.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4380.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2642.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52281 - OR36052281", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14149.1, "discounted_cash": 2089, "minimum": 814.9882, "maximum": 13866.118, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2026.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4179.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2072.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1966.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3134.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1462.73, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2047.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2925.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2214.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1828.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3447.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2612.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1567.21, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15402.3, "discounted_cash": 3523, "minimum": 887.1725, "maximum": 15094.254, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3417.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7047.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3350.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3629.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5285.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2466.58, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3453.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 2030.98, "10th_percentile": 2030.98, "90th_percentile": 2030.98, "count": "1 through 10" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4933.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3735.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6166.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3083.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5814.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4404.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2642.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38578, "minimum": 26100, "maximum": 67511.71, "payers_information": [ { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38578.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 37806.56, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 50151.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 50151.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 36571.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 44851.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 59796.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36226.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 36226.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53476.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 61724.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 60376.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 38578.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38578.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 30862.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30862.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 36226.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 33755.86, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 50151.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 34501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 63653.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 34720.31, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 34720.31, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38578.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46190.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 38578.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 34501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 38578.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 28933.59, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37420.78, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 67511.71, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 43505.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 37074.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 34501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 38578.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 35536.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 34501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 38578.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27004.68, "additional_payer_notes": "70.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Bone 1St 20 Sq Cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15721.3, "discounted_cash": 1650, "minimum": 405.216, "maximum": 15406.874, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy W/Biopsy(S)", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17293.4, "discounted_cash": 2089, "minimum": 996.0998, "maximum": 16947.532, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2026.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4179.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2072.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1966.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3134.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1462.73, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2047.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2925.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2214.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3238.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1671.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 2194.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1828.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2716.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3447.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2612.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1880.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1567.21, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Deb skin bone at fx site", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7536.96, "discounted_cash": 2903, "minimum": 434.1289, "maximum": 7386.2208, "payers_information": [ { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero W/Excise Tumor", "code_information": [ { "code": "52355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25154, "discounted_cash": 5359, "minimum": 1448.8704, "maximum": 24650.92, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5199.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10719.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4951 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4697.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5501.11 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5501.11 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5520.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 8039.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3751.88, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5252.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7503.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6967.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5681.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6967.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8307.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5627.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5627.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8307.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9379.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4287.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4287.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5627.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4689.85, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6967.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8843.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6699.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 4823.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 4823.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 4019.87, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36208, "minimum": 17550, "maximum": 63364.9975, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35122.31, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 63365, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 41924.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 35726.76 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 32401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 36208.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 33373.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 32401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 36208.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25346, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36208.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 35484.4, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 47071.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 47071.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 34345.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 42121.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 56123.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34021.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 34021.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50221.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 57933.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 56701.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 36208.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36208.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 28966.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28966.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 34021.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 31682.5, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 47071.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 32401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 59744.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 32587.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 32587.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36208.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36840.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 36208.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 32401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 36208.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 27156.43, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11647.88, "maximum": 15300, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13668.47 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 11647.88 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12882.2 } ] } ] }, { "description": "Create Eardrum Opening", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 1551, "minimum": 595.8432, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1504.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3102.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1578.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1497.77 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1754.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1754.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1597.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2326.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1085.71, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1519.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2171.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2016.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1644.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2016.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2404.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1628.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1628.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2404.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2714.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1240.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1240.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1628.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1357.13, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2016.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2559.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 1938.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1395.91, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1395.91, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1551.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1163.26, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Subq Tis 1St 20Sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12930.6, "discounted_cash": 406, "minimum": 101.2608, "maximum": 12671.988, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 812.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 373.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 354.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 415.36 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 415.36 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 418.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 609.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.45, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 398.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 426.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 711.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 325.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 325.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 426.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 355.57, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 507.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 365.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 365.72, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 304.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Deep Muscle Biopsy", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15721.3, "discounted_cash": 2903, "minimum": 905.5469, "maximum": 15406.874, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13819, "minimum": 9673.895, "maximum": 24184.7375, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13405.25, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24184.74, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13477.64 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 11485.26 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12558.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13819.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12558.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12935.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 12558.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13819.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9673.9, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13819.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 13543.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17965.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 17965.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13312.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16326.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21420.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13186.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13186.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19466.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 22111.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 21977.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13819.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13819.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11055.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11055.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13186.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12092.37, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 17965.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 12558.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12558.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 22802.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12437.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12437.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13819.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15270.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13819.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 12558.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12558.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13819.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10364.89, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17424, "minimum": 12196.954, "maximum": 30492.385, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16901.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 30492.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16763.36 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14285.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15753.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 17424.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15753.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16225.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15753.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17424.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12196.95, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17424.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 17075.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22651.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 22651.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 20479.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27007.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16540.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16540.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24417.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 27878.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 27568.28, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 17424.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17424.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13939.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13939.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 16540.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 15246.19, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 22651.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15753.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15753.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 28749.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15681.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15681.8, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17424.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15275 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17424.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15753.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15753.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17424.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 13068.17, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8795, "minimum": 5507.82, "maximum": 15392.65, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8531.93, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15392.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6991.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8106.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8106.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8349.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8106.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6157.06, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8619.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11434.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11434.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8592.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10538.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13633.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8511.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8511.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12564.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 14073.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14185.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7036.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7036.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8511.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7696.33, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11434.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8106.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8106.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14513.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7916.22, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7916.22, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5507.82 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8106.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8106.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8795.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6596.85, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cysto W/Irrg&Evac Mlt Clots", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 3523, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3417.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7047.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3531.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3350.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3924.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3629.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5285.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2466.58, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3453.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4933.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3735.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6166.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3083.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5814.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4404.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2642.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10784, "minimum": 706, "maximum": 18872.945, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10461, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18872.95, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "per diem", "standard_charge_dollar": 938 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "per diem", "standard_charge_dollar": 706 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9868.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10784.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9868.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10164.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9868.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10784.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7549.18, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10784.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10568.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14019.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14019.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10460.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12829.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16716.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10362.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10362.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15296.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 17255.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 17270.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10784.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10784.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8627.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8627.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10362.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9436.47, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14019.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9868.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9868.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17794.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9706.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9706.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10784.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4335.95 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10784.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9868.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9868.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10784.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8088.41, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31442.5, "discounted_cash": 5359, "minimum": 1500, "maximum": 30813.65, "payers_information": [ { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10719.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4951 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4697.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5501.11 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5501.11 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5520.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 8039.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3751.88, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5252.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7503.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6967.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5681.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6967.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8307.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5627.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5627.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8307.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9379.7, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4287.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4287.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5627.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4689.85, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6967.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8843.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6699.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 4823.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 4823.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5359.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 4019.87, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5199.04, "additional_payer_notes": "97.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52224 - OR36052224", "code_information": [ { "code": "52224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 3523, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3417.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7047.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2072.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1966.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2303.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3629.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5285.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2466.58, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3453.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4933.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3735.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5461.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6166.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2818.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3699.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 3083.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4580.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5814.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4404.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 3171.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3523.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2642.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20267, "minimum": 14187.495, "maximum": 35468.7375, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19659.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 35468.74, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19125.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16298.49 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18273.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 20267.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18273.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18821.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18273.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20267.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14187.5, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20267.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 19862.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 26348.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 26348.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19369.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 23755.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31415.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19187.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19187.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28323.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 32428.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 31978.45, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 20267.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20267.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16214.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16214.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 19187.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17734.37, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 26348.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18273.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18273.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 33441.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18241.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18241.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20267.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14406.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20267.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18273.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18273.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20267.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15200.89, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8285.36, "maximum": 11623.4985, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10461.64 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8915.11 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8285.36 } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8048, "minimum": 4334.06, "maximum": 14085.295, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7807.28, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14085.3, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6495.75 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5535.49 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7444.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8048.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7444.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7667.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7444.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8048.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5634.12, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8048.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 7887.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10463.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 10463.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 9677.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12475.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7816.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11538.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 12877.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13027.21, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8048.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8048.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6438.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6438.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7816.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7042.65, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 10463.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7444.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7444.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13280.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7243.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7243.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8048.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4334.06 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8048.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7444.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7444.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8048.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6036.56, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Diag Laparo Separate Proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18236.3, "discounted_cash": 6043, "minimum": 1050.4109, "maximum": 17871.574, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5862.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 12086.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5655.44 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5365.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6283.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6283.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 6224.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 9064.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4230.32, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5922.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8460.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7856.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6345.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6345.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9367.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10575.79, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4834.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4834.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 6345.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 5287.9, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "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 STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 3258.79, "10th_percentile": 3258.79, "90th_percentile": 3258.79, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 7554.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 5438.98, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 5438.98, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 6043.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 4532.48, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22612, "minimum": 15828.806, "maximum": 39572.015, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21934.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 39572.02, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23318.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 19871.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 20351.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 22612.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20351.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20962.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 20351.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 22612.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15828.81, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22612.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 22160.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 29396.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 29396.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21572.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 26456.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 35049.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21369.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 21369.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31544.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 36180.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 35615.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 22612.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22612.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 18090.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18090.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 21369.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 19786.01, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 29396.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 20351.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20351.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 37310.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 20351.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 20351.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22612.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22866.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 22612.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 20351.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20351.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 22612.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 16959.44, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13083, "minimum": 9158.737, "maximum": 22896.8425, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12691.39, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22896.84, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12845.44 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10946.52 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13083.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12263.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13083.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9158.74, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13083.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12822.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17009.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 17009.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12621, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 15478.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20280.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12501.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12501.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18455.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20934.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20836.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13083.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13083.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10467.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10467.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12501.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11448.42, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 17009.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21588.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11775.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11775.52, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13083.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10845.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13083.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13083.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9812.93, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10518, "minimum": 7362.88, "maximum": 18407.2, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10202.85, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18407.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9478.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8077.47 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9632.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10518.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9632.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9921.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9632.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10518.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7362.88, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10518.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10308.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13673.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13673.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10210.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12522.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16303.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10114.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10114.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14930.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16829.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16857.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10518.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10518.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8414.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8414.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10114.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9203.6, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13673.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9632.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9632.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17355.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9466.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9466.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10518.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7756.13 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10518.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9632.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9632.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10518.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7888.8, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21034, "minimum": 14724.213, "maximum": 36810.5325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20403.55, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36810.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22045.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 18786.87 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18953, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 21034.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18953, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19521.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18953, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21034.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14724.21, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21034.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 20613.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 27344.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 27344.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20090.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 24638.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32603.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19900.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19900.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29377.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 33655.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 33167.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 21034.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21034.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16827.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16827.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 19900.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18405.27, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 27344.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18953, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18953, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 34707.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18931.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18931.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21034.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20534.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21034.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18953, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18953, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21034.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15775.94, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16683, "minimum": 11678.205, "maximum": 29195.5125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16182.66, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29195.51, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17018.15 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14502.39 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15096.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16683.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15096.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15549.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15096.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16683.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11678.21, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16683.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16349.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21688.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21688.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16002.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19625.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25858.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15851.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15851.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23399.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 26693.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 26418.88, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16683.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16683.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13346.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13346.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15851.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14597.76, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21688.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15096.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15096.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27527.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15014.84, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15014.84, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16683.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15429.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16683.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15096.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15096.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16683.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12512.36, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8050, "minimum": 5413.31, "maximum": 14088.2875, "payers_information": [ { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8050.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6440.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6440.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7817.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7044.14, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 10465.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7445.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7445.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13283.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7245.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7245.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8050.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5413.31 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8050.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7445.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8050.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6037.84, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7808.94, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14088.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6459.5 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5504.6 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7445.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8050.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7445.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7669, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7445.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8050.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5635.32, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8050.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 7889.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10465.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 10465.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7892.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 9679.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12478.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7817.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7817.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11540.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 12880.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13029.85, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8050.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19559, "minimum": 706, "maximum": 34228.775, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18972.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 34228.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "per diem", "standard_charge_dollar": 938 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "per diem", "standard_charge_dollar": 706 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17645.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 19559.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17645.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18174.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 17645.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19559.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13691.51, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19559.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 19168.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25427.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 25427.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18704.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 22939.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30316.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18527.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18527.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27350.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 31294.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 30879.63, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 19559.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19559.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 15647.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15647.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 18527.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17114.39, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 25427.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 17645.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17645.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 32272.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 17603.37, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 17603.37, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19559.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11585.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19559.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 17645.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17645.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19559.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14669.48, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9812, "minimum": 6330.02, "maximum": 17171.735, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9518.05, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17171.74, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8701.51 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7415.18 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9007.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9812.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9007.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9277.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9007.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9812.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6868.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9812.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9616.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12756.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12756.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9547.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11709.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15209.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9457.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9457.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13961.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15699.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.6, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9812.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9812.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7849.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7849.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9457.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8585.87, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12756.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9007.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9007.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16190.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8831.18, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8831.18, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9812.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6330.02 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9812.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9007.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9007.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9812.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7359.32, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12098, "minimum": 8302.37, "maximum": 21171.675, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11735.16, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21171.68, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11479.76 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9782.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11032.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12098.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11032.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11363.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11032.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12098.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8468.67, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12098.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11856.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 15727.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 15727.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11694.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 14342.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18752.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11584.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11584.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17101, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 19356.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 19307.58, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12098.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12098.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9678.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9678.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11584.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10585.84, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 15727.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11032.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11032.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 19961.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10888.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10888.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12098.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8302.37 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12098.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11032.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11032.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12098.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9073.58, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Drain Shoulder Lesion", "code_information": [ { "code": "23030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31442.5, "discounted_cash": 2903, "minimum": 1500, "maximum": 30813.65, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9164, "minimum": 6415.234, "maximum": 16038.085, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8889.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16038.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7841.17 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6682.02 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8433.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9164.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8433.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8686.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8433.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9164.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6415.23, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9164.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8981.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11914.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11914.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8939.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10963, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14205.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8854.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8854.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13071.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 14663.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14757.89, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9164.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9164.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7331.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7331.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8854.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8019.04, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11914.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8433.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8433.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15121.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8248.16, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8248.16, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7258.08 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9164.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8433.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8433.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9164.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6873.47, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9931, "minimum": 6951.952, "maximum": 17379.88, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9633.42, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17379.88, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9002.15 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7671.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9112.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9931.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9112.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9386, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9112.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9931.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6951.95, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9931.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9732.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12910.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12910.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9659.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11846.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15393.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9568.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9568.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14124.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15890.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15947.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9931.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9931.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7945.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7945.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9568.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8689.94, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12910.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9112.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9112.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 16386.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8938.22, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8938.22, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9931.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7202.32 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9931.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9112.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9112.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9931.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7448.52, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10402, "minimum": 5985.09, "maximum": 18203.535, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10089.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18203.54, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9375.28 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7989.35 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9529.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10402.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9529.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9815.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9529.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10402.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7281.41, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10402.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10193.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13522.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13522.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10101.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12388.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16123.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10006.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10006.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14771.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16643.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16677.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10402.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10402.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8321.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8321.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10006.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9101.77, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13522.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9529.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9529.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17163.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9361.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9361.82, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10402.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5985.09 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10402.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9529.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9529.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10402.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7801.52, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9553, "minimum": 6687.786, "maximum": 16719.465, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9267.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16719.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8382.74 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7143.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8778.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9553.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8778.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9041.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8778.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9553.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6687.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9553.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9362.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12420.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12420.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9304.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11411.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14808.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9217.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9217.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13606.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15286.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15361.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9553.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9553.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7643.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7643.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9217.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8359.73, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12420.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8778.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15764.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8598.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8598.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9553.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8399.72 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9553.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8778.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8778.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9553.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7165.49, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15027, "minimum": 10106.5, "maximum": 26297.775, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14576.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26297.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14655.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12489.15 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13628.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 15027.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13628.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14037.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13628.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15027.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10519.11, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15027.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14726.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19535.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 19535.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14446.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 17717.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23292.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14310.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14310.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 24043.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 23850.58, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 15027.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15027.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12021.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12021.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14310.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13148.89, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 19535.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13628.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13628.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24795.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13524.57, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13524.57, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15027.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10106.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15027.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13628.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13628.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15027.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11270.48, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17031, "minimum": 11922.008, "maximum": 29805.02, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16520.5, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29805.02, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17791.08 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15161.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 17031.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15867.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17031.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11922.01, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17031.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16690.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22140.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 22140.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16329.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 20026.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26398.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16175.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16175.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23877.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 27250.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 26958.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 17031.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17031.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13625.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13625.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 16175.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14902.51, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 22140.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 28101.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15328.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15328.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17031.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12655.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17031.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17031.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12773.58, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Diagnostic Colonoscopy", "code_information": [ { "code": "45378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 929, "minimum": 232.1021, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 901.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1859.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 893.74 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 847.91 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 993.04 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 993.04 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 957.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1394.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 650.73, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 911.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1208.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 976.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 976.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1440.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1626.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 743.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 743.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 976.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 813.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 1162.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 836.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 836.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 929.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 697.21, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Echo Transesophageal", "code_information": [ { "code": "93312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 546, "minimum": 232.89, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 529.82, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1092.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 449.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 406.2 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 502.19 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 450.72 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 450.72 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 562.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 462.96 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 819.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 382.35, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 535.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 462.96 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 448.57 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 764.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 578.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 710.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 246.86 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 846.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 573.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 476.45 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 501.13 }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 573.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 846.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 955.87, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 436.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 436.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 573.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 477.93, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 710.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 435.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 449.48 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 472.77 }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 901.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 682.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 491.59, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 491.59, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 235.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 441.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 455.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 478.88 }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 546.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 409.66, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10642, "minimum": 7449.736, "maximum": 18624.34, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10323.21, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18624.34, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9543.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8132.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9742.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10642.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9742.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10035.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9742.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10642.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7449.74, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10642.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10429.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13835.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13835.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16495.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10229.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10229.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15101.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 17027.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 17049.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10642.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10642.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8513.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8513.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10229.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9312.17, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13835.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9742.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9742.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17560.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9578.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10642.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8394.99 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10642.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9742.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9742.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10642.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7981.86, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Egd Biopsy Single/Multiple", "code_information": [ { "code": "43239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 906, "minimum": 243.6572, "maximum": 12325.46, "payers_information": [ { "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.64, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 725.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 725.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 793.32, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 1133.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 815.99, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 815.99, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 679.99, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 879.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 919.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 872.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1021.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1021.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 933.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 634.66, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 888.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1269.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dilation And Curettage", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9817.94, "discounted_cash": 3235, "minimum": 565.5133, "maximum": 9621.5812, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2922.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2772.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2265.16, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3171.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 2407.48, "10th_percentile": 2407.48, "90th_percentile": 2407.48, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5662.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2831.45, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "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": 5.76, "median_amount": 1834.86, "10th_percentile": 1834.86, "90th_percentile": 1834.86, "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": 5.76, "median_amount": 2673.98, "10th_percentile": 2673.98, "90th_percentile": 2673.98, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2426.96, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Drain Thigh/Knee Lesion", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 2903, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Endometrial Cryoablation", "code_information": [ { "code": "58356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 5000, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4850.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10001.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1884.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1787.46 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2093.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2093.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5150.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7500.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3500.43, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 4900.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7000.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5300.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8751.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4000.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4000.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4375.54, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8251.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6250.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 4500.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 4500.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 3750.47, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Drain/Inj Joint/Bursa W/O Us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 306, "minimum": 34.4544, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 297.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 613.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 36.32 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 34.45 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 40.35 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 40.35 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 316.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 460.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 300.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 322.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 475.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.97, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 245.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 245.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 322.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 268.49, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 383.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 276.16, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 276.16, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 306.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 230.13, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10993, "minimum": 7695.338, "maximum": 19238.345, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10663.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19238.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9931.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8463.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10053.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10993.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10053.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10355.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10053.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10993.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7695.34, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10993.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10773.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14291.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14291.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13069.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17039.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10556.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10556.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15583.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 17589.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 17594.15, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10993.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10993.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8794.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8794.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10556.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9619.17, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14291.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10053.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10053.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18139.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9894.01, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9894.01, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10993.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8813.65 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10993.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10053.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10053.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10993.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8245.01, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13613, "minimum": 9529.527, "maximum": 23823.8175, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13205.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23823.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13871.03 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 11820.49 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13613.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12747.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 12376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13613.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9529.53, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13613.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 13341.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17697.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 17697.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13118.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16088.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21101.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12994.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12994.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19182.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 21781.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 21658, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13613.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13613.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10890.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10890.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12994.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11911.91, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 17697.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 12376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 22462.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12252.25, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12252.25, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13613.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11494.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13613.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 12376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12376, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13613.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10210.21, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18090, "minimum": 12663.595, "maximum": 31658.9875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17548.12, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 31658.99, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20082.13 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 17113.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16344, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 18090.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16344, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16834.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 16344, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18090.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12663.6, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18090.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 17729.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 23518.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 23518.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17324.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 21247.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28040.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17161.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17161.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25333.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 28945.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 28602, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 18090.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18090.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 14472.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14472.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 17161.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 15829.49, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 23518.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 16344, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16344, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 29849.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 16281.77, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 16281.77, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18090.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17091.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18090.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 16344, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16344, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18090.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 13568.14, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8720, "minimum": 5676.05, "maximum": 15260.8575, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8458.88, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15260.86, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7066.11 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6021.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8039.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8039.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8280.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8039.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6104.34, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8546.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11336.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11336.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8521.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10451.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13516.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8441.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8441.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12461.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13952.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14069.07, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6976.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6976.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8441.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7630.43, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11336.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8039.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8039.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14388.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7848.44, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7848.44, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5676.05 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8039.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8039.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8720.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6540.37, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Dx Bronchoscope/Wash", "code_information": [ { "code": "31622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 1779, "minimum": 431.0294, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1725.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3558.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1673.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1587.98 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1859.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1859.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1832.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2668.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1245.47, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1743.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2490.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2313.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1868.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3113.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1423.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1423.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1868.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1556.84, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2224.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1601.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1601.32, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1334.43, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20852, "minimum": 13470.9, "maximum": 36491.56, "payers_information": [ { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 18767.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 18767.09, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20852.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13470.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 20852.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 18791.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18791.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20852.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 15639.24, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20226.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36491.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21674.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 18470.71 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 18791.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 20852.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18791.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 19355.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 18791.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 20852.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14596.62, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20852.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 20435.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 27108.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 27108.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19918.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 24428.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32321.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19730.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19730.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29126.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 33363.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 32884.95, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 20852.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20852.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 16681.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16681.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 19730.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18245.78, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 27108.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 18791.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18791.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 34406.33, "additional_payer_notes": "165.00% of Medicare Rates" } ] } ] }, { "description": "Drain external ear lesion", "code_information": [ { "code": "69005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13512.51, "discounted_cash": 1650, "minimum": 148.6179, "maximum": 13242.2598, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 156.65 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 148.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 174.06 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 174.06 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "standard_charge_algorithm": "Not To Exceed $6000", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6000, "10th_percentile": 6000, "90th_percentile": 6000, "count": "1 through 10" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14127, "minimum": 9888.942, "maximum": 24722.355, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13703.25, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24722.36, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14122.63 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12034.9 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12831.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14127.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12831.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13216.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 12831.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14127.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9888.94, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14127.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 13844.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18365.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 18365.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13600.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16680.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21896.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13472.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13472.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19888.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 22603.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 22454.43, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14127.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14127.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11301.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11301.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13472.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12361.18, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 18365.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 12831.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12831.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 23309.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12714.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12714.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14127.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14499.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14127.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 12831.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12831.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14127.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10595.3, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Drain Lower Leg Lesion", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28298.3, "discounted_cash": 2903, "minimum": 1500, "maximum": 27732.334, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9014, "minimum": 4706.41, "maximum": 15774.5175, "payers_information": [ { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6309.81, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9014.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 8833.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 11718.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 11718.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8797.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 10789.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13971.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8714.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8714.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12864.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 14422.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14524.3, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9014.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9014.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7211.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7211.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8714.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7887.26, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 11718.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8299.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8299.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 14873.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8112.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8112.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9014.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4706.41 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9014.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8299.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8299.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9014.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6760.51, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8743.59, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15774.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7857.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6695.65 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8299.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9014.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8299.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8548.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8299.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9014.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11504, "minimum": 7758.02, "maximum": 20132.3675, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11159.08, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20132.37, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10856.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9251.26 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11504.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10821.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11504.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8052.95, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11504.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11274.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14955.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14955.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11137, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17831.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11031.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16285.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 18406.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 18386.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11504.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11504.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9203.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9203.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11031.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10066.18, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14955.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18981.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10353.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10353.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11504.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7758.02 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11504.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11504.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8628.16, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 184365, "minimum": 108450, "maximum": 322639.4675, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 178834.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 322639.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 202465.18 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 172535.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 163707, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 184365.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 163707, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 168618.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 163707, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 184365.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 129055.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 184365.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 180678.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 239675.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 239675.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 173529.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 212819.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 285766.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 171892.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 171892.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 253745.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 294984.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 286487.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 184365.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 184365.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 147492.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 147492.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 171892.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 161319.73, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 239675.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 163707, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 163707, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 304202.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 165928.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 165928.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 184365.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 244340 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 184365.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 163707, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 163707, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 184365.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 138274.06, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Finger Abscess", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 1650, "minimum": 595.8432, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Endometr Ablate Thermal", "code_information": [ { "code": "58353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13910.3, "discounted_cash": 5000, "minimum": 801.2333, "maximum": 13632.094, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4850.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10001.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4997.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4741.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5553 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5553 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5150.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7500.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3500.43, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 4900.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7000.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5300.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7750.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8751.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4000.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4000.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5250.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4375.54, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6500.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 8251.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6250.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 4500.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 4500.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5000.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 3750.47, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Hip Joint", "code_information": [ { "code": "27030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18865.5, "discounted_cash": 7253, "minimum": 1080.8958, "maximum": 18488.19, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7035.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 14507.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1139.32 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1080.9 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1265.91 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1265.91 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7471.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 10880.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5077.49, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 7108.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10154.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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": 11243.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12693.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 5802.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5802.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 6346.87, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 6528.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 6528.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 5440.17, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16819, "minimum": 11773.454, "maximum": 29433.635, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16314.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29433.64, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17732.44 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15111.08 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15217, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16819.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15217, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15673.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15217, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16819.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11773.45, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16819.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16482.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21864.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21864.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16130.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19782.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26069.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15977.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15977.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23586.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 26910.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 26629.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16819.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16819.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13455.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13455.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15977.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14716.82, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21864.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15217, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15217, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27751.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15137.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15137.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16819.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14011.5 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16819.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15217, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15217, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16819.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12614.42, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9307, "minimum": 4867.08, "maximum": 16288.1775, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9028.3, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16288.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8185.52 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6975.46 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8559.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9307.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8559.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8816.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8559.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9307.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6515.27, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9307.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9121.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12099.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12099.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9073.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11127.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14426.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8987.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8987.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13267.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 14892.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 14979.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9307.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9307.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7446.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7446.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 8987.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8144.09, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12099.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8559.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8559.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15357.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8376.78, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8376.78, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9307.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4867.08 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9307.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8559.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8559.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9307.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6980.65, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Dx Bronchoscope/Lavage", "code_information": [ { "code": "31624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12245.8, "discounted_cash": 1779, "minimum": 431.0294, "maximum": 12000.884, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1725.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3558.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1673.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1587.98 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1859.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1859.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1832.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2668.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1245.47, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1743.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2490.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2313.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1868.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3113.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1423.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1423.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1868.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1556.84, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "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 STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1122.69, "10th_percentile": 1122.69, "90th_percentile": 1122.69, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2224.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1601.32, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1601.32, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1779.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1334.43, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13586, "minimum": 9510.361, "maximum": 23775.9025, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13178.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23775.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13266.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 11305.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13586.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12722.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 12351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13586.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9510.36, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13586.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 13314.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17662.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 17662.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13092.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16057.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21058.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12969.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12969.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19145.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 21737.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 21615.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13586.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13586.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10868.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10868.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12969.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11887.95, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 17662.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 12351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 22417.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12227.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12227.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13586.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9788.01 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13586.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 12351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12351.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13586.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10189.67, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Ex Arm/Elbow Tum Deep 5 Cm/>", "code_information": [ { "code": "24073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53452.3, "discounted_cash": 2903, "minimum": 1500, "maximum": 52383.254, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55176, "minimum": 11700, "maximum": 96558.0875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 53520.77, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 96558.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 75663.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 64478.06 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 49211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 55176.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 50687.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 49211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 55176.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38623.24, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55176.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 54072.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 71728.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 71728.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 52163.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 63974.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 85522.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51671.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 51671.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 76277.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 88281.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 86119.6, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 55176.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 55176.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 44140.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 44140.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 51671.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 48279.04, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 71728.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 49211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 91040.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 49658.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 49658.45, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55176.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39697.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 55176.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 49211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49211.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 55176.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 41382.04, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXC ARMELBOW LES SC < 3 CM", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4927.82, "discounted_cash": 1650, "minimum": 283.8424, "maximum": 4829.2636, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43472, "minimum": 3824.67, "maximum": 76077.6625, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42168.76, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 76077.66, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 59711.19 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 50884.18 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 38839.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 43472.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38839.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 40004.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 38839.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 43472.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30431.07, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43472.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 42603.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 56514.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 56514.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 41169.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 50490.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 67383.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40781.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 40781.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 60200.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 69556.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 67968.6, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 43472.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43472.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 34778.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34778.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 40781.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 38038.83, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 56514.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 38839.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38839.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 71730.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 39125.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 39125.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43472.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3824.67 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 43472.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 38839.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38839.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 43472.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 32604.71, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Bartholins Gland/Cyst", "code_information": [ { "code": "56740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 3235, "minimum": 595.8432, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2922.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2772.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2265.16, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3171.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5662.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2831.45, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2426.96, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 0.5/<", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 1650, "minimum": 98.5458, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 103.87 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 98.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 115.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 115.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Abd Les Sc 3 Cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12930.6, "discounted_cash": 2903, "minimum": 744.8026, "maximum": 12671.988, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 0.6-1", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9214.77, "discounted_cash": 707, "minimum": 115.773, "maximum": 9030.4746, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 686.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 122.03 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 115.77 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 135.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 135.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 495.5, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 693.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 991, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1238.76, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 619.38, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 530.9, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Forearm Les Sc < 3 Cm", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 1650, "minimum": 595.8432, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hand Les Sc < 1.5 Cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 1650, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11950.7, "discounted_cash": 1650, "minimum": 128.1939, "maximum": 11711.686, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 157.1, "10th_percentile": 157.1, "90th_percentile": 157.1, "count": "1 through 10" }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 135.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 128.19 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 150.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 150.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hip/Pelv Tum Deep 5 Cm/>", "code_information": [ { "code": "27045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15721.3, "discounted_cash": 2903, "minimum": 905.5469, "maximum": 15406.874, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Leg/Ankle Tum < 3 Cm", "code_information": [ { "code": "27618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23436, "discounted_cash": 1650, "minimum": 1155.693, "maximum": 22967.28, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc legankle les sc 3 cm>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25154, "discounted_cash": 2903, "minimum": 1448.8704, "maximum": 24650.92, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXC NECK LES SC < 3 CM", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8107.52, "discounted_cash": 1650, "minimum": 466.9932, "maximum": 7945.3696, "payers_information": [ { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC NECK TUM DEEP < 5 CM", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9273.99, "discounted_cash": 2903, "minimum": 534.1818, "maximum": 9088.5102, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXC NECK LES SC 3 CM>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23150.18, "discounted_cash": 2903, "minimum": 1333.4504, "maximum": 22687.1764, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "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 STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1655.15, "10th_percentile": 1655.15, "90th_percentile": 1655.15, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Les Sc < 3 Cm", "code_information": [ { "code": "23075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15516.8, "discounted_cash": 1650, "minimum": 893.7677, "maximum": 15206.464, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Tum Deep < 5 Cm", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 2903, "minimum": 595.8432, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9404, "minimum": 6094.7, "maximum": 16457.4025, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9122.1, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16457.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8149.27 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6944.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8645.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8645.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8904.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8645.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6582.96, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9216.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12225.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12225.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11239.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14576.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9077.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9077.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13400.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15046.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15129.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7523.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7523.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9077.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8228.7, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12225.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8645.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8645.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15516.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8463.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8463.81, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6094.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8645.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8645.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9404.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7053.17, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 2.1-3Cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 707, "minimum": 138.6057, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 686.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 146.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 138.61 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 162.33 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 162.33 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 495.5, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 693.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 991, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1238.76, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 619.38, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 530.9, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 0.6-1 Cm", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15721.3, "discounted_cash": 406, "minimum": 116.9718, "maximum": 15406.874, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 812.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 123.29 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 116.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 136.99 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 136.99 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 418.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 609.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.45, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 398.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 426.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 711.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 325.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 325.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 426.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 355.57, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 507.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 365.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 365.72, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 406.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 304.77, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 3.1-4 Cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14223.7, "discounted_cash": 1650, "minimum": 819.2851, "maximum": 13939.226, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext mal+marg 0.6-1 cm", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5172.25, "discounted_cash": 707, "minimum": 168.2538, "maximum": 5068.805, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 686.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 177.35 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 168.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 197.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 197.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 495.5, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 693.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 991, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1238.76, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 619.38, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 530.9, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext mal+marg >4 cm", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8620.42, "discounted_cash": 1650, "minimum": 496.5362, "maximum": 8448.0116, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" } ] } ] }, { "description": "Evacuate Mole Of Uterus", "code_information": [ { "code": "59870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11460.8, "discounted_cash": 3235, "minimum": 660.1421, "maximum": 11231.584, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2922.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2772.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2265.16, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3171.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5662.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2831.45, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2426.96, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Excision Of Anal Lesion(S)", "code_information": [ { "code": "46922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 2774, "minimum": 595.8432, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2691.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5549.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2742.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2602.04 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3047.43 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3047.43 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2857.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4161.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1942.25, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2719.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3884.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3607.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2941.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3607.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4300.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2913.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2913.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4855.62, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2219.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2219.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 2913.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2427.81, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 3607.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4578.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3468.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2497.18, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2497.18, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2774.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2080.98, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Ex Arm/Elbow Tum Deep < 5 Cm", "code_information": [ { "code": "24076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12930.6, "discounted_cash": 2903, "minimum": 744.8026, "maximum": 12671.988, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Excision Vaginal Cyst/Tumor", "code_information": [ { "code": "57135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10081.3, "discounted_cash": 3235, "minimum": 580.6829, "maximum": 9879.674, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3138.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6471.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2922.78 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2772.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3247.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2265.16, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3171.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4530.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3430.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5015.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5662.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2588.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3397.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2831.45, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4206.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "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": 5.76, "median_amount": 1834.86, "10th_percentile": 1834.86, "90th_percentile": 1834.86, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5339.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2912.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2426.96, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Arm/Elbow Les Sc 3 Cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12998.8, "discounted_cash": 2903, "minimum": 748.7309, "maximum": 12738.824, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 185437, "minimum": 108000, "maximum": 324515.8875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 179874.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 324515.89, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 164657, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 185437.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 164657, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 169596.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 164657, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 185437.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 129806.36, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 185437.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 181728.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 241068.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 241068.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 174536.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 214054.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 287428.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 172889.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 172889.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 255218.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 296700.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 288149.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 185437.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 185437.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 148350.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 148350.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 172889.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 162257.94, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 241068.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 164657, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 164657, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 305972.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 166893.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 166893.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 185437.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 248857 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 185437.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 164657, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 164657, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 185437.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 139078.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29205.5, "discounted_cash": 2903, "minimum": 1500, "maximum": 28621.39, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36057, "minimum": 11700, "maximum": 63099.9425, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34975.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 63099.94, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 32266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 36057.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 33234.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 32266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 36057.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25239.98, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36057.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 35335.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 46874.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 46874.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 34202.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 41946.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 55888.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33880.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 33880.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50013.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 57691.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 56466.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 36057.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36057.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 28845.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28845.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 33880.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 31549.97, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 46874.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 32266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 59494.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 32451.4, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 32451.4, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36057.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45390.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 36057.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 32266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 36057.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 27042.83, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Les Sbq 2 Cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12930.6, "discounted_cash": 1650, "minimum": 639.7929, "maximum": 12671.988, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 674.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 639.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 749.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 749.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Foot/Toe Tum Sc 1.5 Cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22009.8, "discounted_cash": 2903, "minimum": 1267.7645, "maximum": 21569.604, "payers_information": [ { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17400, "minimum": 9000, "maximum": 30450.455, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16878.25, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 30450.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17641.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15033.86 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15732, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 17400.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15732, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16203.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15732, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17400.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12180.18, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17400.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 17052.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 22620.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 22620.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16675.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 20451.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26970.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16518.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16518.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24384.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 27840.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 27531, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 17400.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17400.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13920.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13920.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 16518.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 15225.23, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 22620.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15732, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15732, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 28710.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 15660.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 15660.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17400.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12002.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 17400.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15732, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15732, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 17400.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 13050.2, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Excise Wrist Tendon Sheath", "code_information": [ { "code": "25118", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 1607, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1559.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3214.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1585.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1504.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1762.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1762.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1655.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1125.17, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1575.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2250.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1703.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2812.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1285.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1285.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1406.47, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2009.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1446.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1446.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1205.54, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Abdl Tum Deep < 5 Cm", "code_information": [ { "code": "22900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 2903, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC BACK LES SC 3 CM>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10860.8, "discounted_cash": 1650, "minimum": 625.5821, "maximum": 10643.584, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "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 STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1038.85, "10th_percentile": 1038.85, "90th_percentile": 1038.85, "count": "1 through 10" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30904, "minimum": 21633.29, "maximum": 54083.225, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29977.56, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 54083.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 34911.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 29750.65 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 27700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 30904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 28531.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 27700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 30904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21633.29, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 30286.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 40176.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 40176.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29362.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 36010.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 47902.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29085.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 29085.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42935.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 49447.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 48475.88, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 30904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 24723.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24723.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 29085.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 27041.61, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 40176.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 27700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 50992.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 27814.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 27814.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43067.4 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 30904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 27700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 30904.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 23178.53, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16618, "minimum": 8550, "maximum": 29081.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16119.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29081.71, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17668.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 15056.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 15038.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16618.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15038.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15489.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 15038.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16618.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11632.68, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16618.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 16285.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21603.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21603.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15941.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19550.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25758.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15790.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15790.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23310.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 26588.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 26317.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16618.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16618.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 13294.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13294.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15790.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14540.86, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21603.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 15038.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15038.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 27419.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14956.31, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14956.31, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16618.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18936.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16618.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 15038.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15038.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16618.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12463.59, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face-Mm B9+Marg 0.6-1 Cm", "code_information": [ { "code": "11441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12930.6, "discounted_cash": 707, "minimum": 126.5844, "maximum": 12671.988, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 686.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 133.43 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 126.58 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 148.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 148.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 495.5, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 693.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 991, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1238.76, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 619.38, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 530.9, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12792, "minimum": 5400, "maximum": 22386.175, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12408.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22386.18, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12142.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 10347.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 11648, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 12792.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11648, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 11997.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 11648, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12792.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8954.47, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12792.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 12536.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 16629.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 16629.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12346.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 15142.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19827.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12230.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12230.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18054.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 20467.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 20384, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 12792.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12792.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10233.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10233.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 12230.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11193.09, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 16629.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 11648, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11648, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 21106.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 11512.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 11512.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12792.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15472.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 12792.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 11648, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11648, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 12792.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 9594.08, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23771, "minimum": 16639.875, "maximum": 41599.6875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23058.11, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41599.69, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 27093.87 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 23088.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 21378.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 23771.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21378.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 22019.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 21378.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23771.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16639.88, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23771.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 23295.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 30902.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 30902.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22661.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 27791.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36845.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22447.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 22447.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33136.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 38034, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 37412.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 23771.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23771.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 19017, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19017, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 22447.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 20799.84, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 30902.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 21378.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21378.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 39222.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 21394.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 21394.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23771.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22464.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 23771.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 21378.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21378.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 23771.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 17828.44, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXC FOREARM LES SC 3 CM>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5172.25, "discounted_cash": 1650, "minimum": 297.9216, "maximum": 5068.805, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXC NECK TUM DEEP 5 CM>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10810.02, "discounted_cash": 2903, "minimum": 622.6572, "maximum": 10593.8196, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Famotidine In Nacl 0.9% Iv Soln 20 Mg/50Ml", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "00338519741", "type": "NDC" }, { "code": "J1308", "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": 5.76, "median_amount": 0.62, "10th_percentile": 0.62, "90th_percentile": 1.23, "count": "1 through 10" } ] } ] }, { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14223.7, "discounted_cash": 1650, "minimum": 819.2851, "maximum": 13939.226, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Tum Deep 5 Cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689, "discounted_cash": 2903, "minimum": 1191.6864, "maximum": 20275.22, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Thigh/Knee Les Sc 3 Cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12577, "discounted_cash": 2903, "minimum": 724.4352, "maximum": 12325.46, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3774.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4500.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5081.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2322.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3048.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2540.69, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3629.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2613.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2816.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5807.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2713.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2573.97 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3014.56 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 2990.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4355.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2032.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2903.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 2845.58, "additional_payer_notes": "98.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11950.7, "discounted_cash": 1650, "minimum": 688.3603, "maximum": 11711.686, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1601.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3301.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1605.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1523.59 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1784.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1700.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2476.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1617.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2146.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2559.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2889.23, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1320.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1733.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1444.62, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2063.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1485.89, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1650.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1238.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 1.1-2 Cm", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10344.5, "discounted_cash": 707, "minimum": 127.7943, "maximum": 10137.61, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 686.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1415.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 134.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 127.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 149.67 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 149.67 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1061.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 495.5, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 693.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 991, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1097.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1238.76, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 566.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 743.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 619.38, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 637.07, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 707.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 530.9, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Excision Graft Extremity", "code_information": [ { "code": "35903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20689, "discounted_cash": 3156, "minimum": 1191.6864, "maximum": 20275.22, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3242.4 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3076.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3602.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3602.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2209.42, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3093.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5523.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2525.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2525.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2761.78, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2840.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2840.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2367.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Famotidine Inj 20 Mg/2Ml - 63323073912", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "63323073912", "type": "NDC" }, { "code": "J1308", "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": 5.76, "median_amount": 0.62, "10th_percentile": 0.62, "90th_percentile": 1.23, "count": "1 through 10" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18728, "minimum": 13109.859, "maximum": 32774.6475, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18166.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32774.65, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18911.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16115.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 18728.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17416.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 16909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18728.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13109.86, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18728.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 18353.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 24346.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 24346.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17923.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 21981.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29028.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17754.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17754.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26209.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 29965.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 29590.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 18728.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18728.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 14982.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14982.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 17754.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 16387.32, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 24346.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 16909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 30901.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 16855.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 16855.53, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18728.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17988.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18728.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 16909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18728.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14046.28, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42882, "minimum": 30017.743, "maximum": 75044.3575, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41596.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 75044.36, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 49123.76 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 41861.86 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 38315.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 42882.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38315.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 39465.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 38315.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 42882.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30017.74, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42882.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 42024.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 55747.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 55747.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 40614.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 49810.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 66467.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40231.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 40231.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 59389.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 68611.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 67052.83, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 42882.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42882.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 34305.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34305.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 40231.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 37522.18, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 55747.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 38315.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38315.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 70756.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 38594.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 38594.24, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42882.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52902.7 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 42882.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 38315.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38315.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 42882.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 32161.87, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26617, "minimum": 18632.208, "maximum": 46580.52, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25818.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 46580.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28024.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 23881.74 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 23900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 26617.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 24617.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 23900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 26617.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18632.21, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26617.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 26085.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 34602.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 34602.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25334.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 31071.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 41257.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25095.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 25095.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37046.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 42587.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 41826.4, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 26617.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26617.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 21293.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21293.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 25095.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 23290.26, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 34602.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 23900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 43918.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 23955.7, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 23955.7, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26617.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27763.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 26617.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 23900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 26617.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 19963.08, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14925, "minimum": 10447.822, "maximum": 26119.555, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14477.7, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26119.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15010.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12791.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14925.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13944.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14925.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10447.82, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14925.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14626.95, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19403.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 19403.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14351.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 17600.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23134.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14215.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14215.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20984.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 23880.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 23692.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14925.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14925.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11940.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11940.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14215.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13059.78, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 19403.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24627.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13432.91, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13432.91, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14925.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12298.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14925.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14925.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11194.1, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15867, "minimum": 11107.341, "maximum": 27768.3525, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15391.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27768.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15493.63 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13203.23 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14373.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 15867.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14373.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14804.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14373.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15867.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11107.34, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15867.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15550.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20627.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 20627.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15236.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 18685.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24594.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15092.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15092.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22279.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 25388.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 25153.98, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 15867.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15867.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12694.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12694.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15092.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13884.18, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 20627.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14373.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14373.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 26181.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14280.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14280.87, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15867.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22005.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15867.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14373.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14373.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15867.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11900.72, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53593, "minimum": 6941.48, "maximum": 93789.1325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51985.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 93789.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 47808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 53593.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 49243.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 47808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 53593.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37515.65, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53593.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 52521.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 69671.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 69671.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 50677.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 62151.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "per diem", "standard_charge_dollar": 7000 }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50199.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 50199.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 74103.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 85750.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 83665.58, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 53593.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 53593.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 42875.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42875.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 50199.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 46894.57, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 69671.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 47808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 88429.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 48234.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 48234.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53593.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6941.48 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 53593.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 47808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 53593.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 40195.34, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9631, "minimum": 4906.76, "maximum": 16854.25, "payers_information": [ { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9631, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8846.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8846.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9631, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7223.25, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9342.07, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16854.25, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8407.26 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7164.43 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8846.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9631, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8846.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9111.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8846.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9631, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6741.7, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9631, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9438.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12520.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12520.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9377.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11500.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14928.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9288.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9288.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13711.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15409.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15481.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9631, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9631, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7704.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7704.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9288.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8427.13, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12520.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8846.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8846.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15891.15, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8667.9, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8667.9, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9631, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4906.76 } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38413, "minimum": 6000, "maximum": 67224.185, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37261.41, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 67224.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 34355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 38413.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 35386.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 34355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 38413.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26889.67, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38413.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 37645.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 49937.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 49937.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 36416.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 44662.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "per diem", "standard_charge_dollar": 6000 }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36073.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 36073.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53251.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 61462.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 60122.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 38413.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38413.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 30731.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30731.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 36073.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 33612.09, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 49937.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 34355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 63382.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 34572.44, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 34572.44, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38413.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43749.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 38413.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 34355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 38413.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 28810.37, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7388, "minimum": 4044.86, "maximum": 12929.1925, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7166.47, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12929.19, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6211.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5292.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 6858.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 7388.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6858.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7064.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 6858.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 7388.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5171.68, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7388.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 7240.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 9604.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 9604.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7270.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 8916.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11451.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7201.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7201.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10630.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 11820.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 12002.59, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 7388.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7388.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 5910.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5910.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7201.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 6464.6, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 9604.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 6858.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6858.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 12190.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 6649.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 6649.3, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4044.86 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 7388.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 6858.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6858.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 7388.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 5541.08, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40875.3, "discounted_cash": 7253, "minimum": 1500, "maximum": 40057.794, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7035.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 14507.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6998.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6639.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7776.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7776.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7471.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 10880.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5077.49, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 7108.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10154.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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": 11243.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12693.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 5802.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5802.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 6346.87, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 6528.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 6528.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 5440.17, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Famotidine Inj 20 Mg/2Ml - 63323073820", "drug_information": { "unit": 20, "type": "ML" }, "code_information": [ { "code": "63323073820", "type": "NDC" }, { "code": "J1308", "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": 5.76, "median_amount": 0.62, "10th_percentile": 0.62, "90th_percentile": 1.23, "count": "1 through 10" } ] } ] }, { "description": "Fusion of foot bones - 28715 - ", "code_information": [ { "code": "28715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26338.33, "discounted_cash": 12833, "minimum": 1500, "maximum": 25811.5634, "payers_information": [ { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22459.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 11229.73, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 16042.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 9625.49, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12448.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25667.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13923.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13209.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15470.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15470.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13219, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 19250.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8983.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 12577.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17967.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18375, "minimum": 12863.067, "maximum": 32157.6675, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17824.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32157.67, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19178.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16343.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16596.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 18375.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16596.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 17094.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 16596.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18375.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12863.07, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18375.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 18008.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 23888.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 23888.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17592.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 21575.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28482.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17426.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17426.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25724.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 29401.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 29044.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 18375.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18375.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 14700.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14700.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 17426.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 16078.83, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 23888.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 16596.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16596.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 30320.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 16538.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 16538.23, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18375.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16010.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18375.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 16596.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16596.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18375.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 13781.86, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14604, "minimum": 6300, "maximum": 25557.98, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14166.42, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25557.98, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14374.23 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12249.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 14604.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 13651.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14604.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10223.19, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14604.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 14312.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 18985.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 18985.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14049.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 17230.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22637.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13917.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13917.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20544.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 23367.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 23195.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 14604.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14604.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 11683.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11683.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13917.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 12778.99, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 18985.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 24097.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13144.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13144.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14604.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18223.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 14604.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 14604.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10953.42, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8127, "minimum": 5689.222, "maximum": 14223.055, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7883.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14223.06, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6792.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5788.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7513.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 8127.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7513.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 7739.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 7513.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8127.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5689.22, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8127.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 7964.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 10565.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 10565.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7964.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 9768.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12597.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7889.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7889.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11646.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 13003.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 13149.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 8127.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8127.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 6501.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6501.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 7889.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 7111.53, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 10565.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 7513.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 13410.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 7314.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 7314.71, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8127.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6448.16 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 8127.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 7513.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7513.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 8127.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 6095.6, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9491, "minimum": 5457.73, "maximum": 16610.1425, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9206.76, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16610.14, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8761.21 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7466.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8722.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9491.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 8984.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8722.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9491.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6644.06, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9491.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9301.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12338.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12338.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9246.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11339.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14711.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9158.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9158.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13520.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15186.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15264.88, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9491.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9491.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7593.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7593.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9158.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8305.07, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12338.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8722.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8722.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15660.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8542.36, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8542.36, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9491.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5457.73 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9491.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8722.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8722.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9491.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7118.63, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15370, "minimum": 10759.315, "maximum": 26898.2875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14909.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26898.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16117.3 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13734.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 13933.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 15370.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13933.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 14351.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 13933.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15370.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10759.32, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15370.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15063.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 19981.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 19981.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14769.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 18113.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23824.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14629.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14629.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21596.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 24592.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 24382.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 15370.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15370.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12296.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12296.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 14629.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 13449.14, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 19981.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 13933.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13933.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 25361.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 13833.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 13833.41, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15370.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11825.6 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 15370.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 13933.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13933.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 15370.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 11527.84, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10329, "minimum": 5969.01, "maximum": 18076.24, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10019.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18076.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9328.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7949.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9465.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10329.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9465.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9749.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9465.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10329.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7230.5, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10329.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10122.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13428.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13428.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10033.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12304.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16010.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9938.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9938.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14671.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16526.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16564.24, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10329.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10329.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8263.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8263.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9938.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9038.12, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13428.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9465.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9465.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17043.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9296.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9296.35, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10329.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5969.01 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10329.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9465.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9465.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10329.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7746.96, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9643, "minimum": 6022.88, "maximum": 16876.72, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9354.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16876.72, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8226.03 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7009.99 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8857.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 9643.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8857.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9123.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 8857.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9643.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6750.69, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9643.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 9450.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 12536.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 12536.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9389.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 11515.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14947.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9300.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9300.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13729.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 15430.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 15501.13, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 9643.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9643.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 7715.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7715.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 9300.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 8438.36, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 12536.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 8857.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8857.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 15912.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 8679.46, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 8679.46, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9643.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6022.88 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 9643.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 8857.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8857.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 9643.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7232.88, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Fixation Of Knee Joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8065, "discounted_cash": 1607, "minimum": 464.544, "maximum": 7903.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1559.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3214.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1585.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1504.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1762.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1762.01 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 1655.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 2411.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1125.17, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 1575.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2250.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1703.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2491.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2812.93, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 1285.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1285.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 1687.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 1406.47, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2089.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 2652.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 2009.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 1446.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 1446.65, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1607.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 1205.54, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 64112, "minimum": 32513.9, "maximum": 112196.945, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 62189.16, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 112196.95, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 57131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 64112.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 58845.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 57131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 64112.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 44878.78, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64112.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 62830.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 83346.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 83346.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 60559.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 74270.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 99374.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 59987.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 59987.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 88553.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 102580.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 99979.78, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 64112.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 64112.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 51290.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51290.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 59987.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 56098.47, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 83346.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 57131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 57131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 105785.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 57701.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 57701.29, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 64112.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32513.9 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 64112.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 57131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 64112.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 48084.41, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30294, "minimum": 16465.8, "maximum": 53015.4625, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29385.71, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 53015.46, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 27159.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 30294.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27159.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 27974.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 27159.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 30294.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21206.19, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30294.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 29688.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 39382.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 39382.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28789.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 35307.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 46956.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28517.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 28517.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42097.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 48471.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 47529.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 30294.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30294.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 24235.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24235.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 28517.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 26507.73, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 39382.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 27159.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27159.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 49986.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 27265.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 27265.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30294.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16465.8 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 30294.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 27159.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27159.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 30294.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 22720.91, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4206) 1 Cc Sterile Syringe&Needle", "code_information": [ { "code": "A4206", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "median_amount": 0.95, "10th_percentile": 0.95, "90th_percentile": 0.95, "count": "1 through 10" } ] } ] }, { "description": "Fusion Of Foot Bones - 28740 - OR36028740", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62885, "discounted_cash": 7253, "minimum": 1500, "maximum": 61627.3, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 6639.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7776.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7776.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7471.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 10880.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5077.49, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 7108.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10154.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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": 11243.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11243.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12693.73, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 5802.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5802.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 7616.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 6346.87, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 11968.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 9066.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 6528.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 6528.2, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7253.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 5440.17, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7035.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 14507.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6998.88 } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18074, "minimum": 12652.213, "maximum": 31630.5325, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17532.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 31630.53, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18911.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16115.88 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 16329.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 18074.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16329.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 16819.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 16329.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18074.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12652.21, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18074.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 17713.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 23496.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 23496.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17309.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 21228.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28015.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17146.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17146.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25310.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 28919.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 28576.8, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 18074.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18074.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 14459.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14459.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 17146.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 15815.27, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 23496.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 16329.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16329.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 29823.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 16267.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 16267.13, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18074.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13550.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 18074.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 16329.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16329.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 18074.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 13555.94, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11481, "minimum": 8036.777, "maximum": 20091.9425, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11136.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20091.94, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10599.17 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9032.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10486.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11481.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10486.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10800.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10486.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11481.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8036.78, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11481.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 11251.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14925.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14925.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11115.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13631.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17795.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11010.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11010.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16253.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 18369.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 18350.68, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11481.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11481.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 9184.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9184.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 11010.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 10045.97, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14925.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10486.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10486.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18943.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10333, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10333, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11481.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9203.97 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11481.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10486.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10486.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11481.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8610.83, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj", "code_information": [ { "code": "93596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14807.6, "discounted_cash": 3240, "minimum": 852.9178, "maximum": 14511.448, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3143.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6481.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5626.89 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4442.28 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6248.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6248.81 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3337.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4861.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2268.52, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3175.93, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4537.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4212.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3435.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4212.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5023.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3402.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3402.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5023.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5671.3, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2592.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2592.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3402.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2835.65, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 4212.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 5347.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4050.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2916.67, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2916.67, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3240.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2430.56, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10396, "minimum": 6950.94, "maximum": 18193.0525, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10084.15, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18193.05, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9283.6 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7911.22 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 9524.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 10396.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9524.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 9810.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 9524.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10396.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7277.22, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10396.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10188.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 13514.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 13514.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10095.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 12381.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16113.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10000.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10000.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14762.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 16633.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 16667.75, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 10396.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10396.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8316.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8316.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10000.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9096.53, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 13514.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 9524.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9524.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 17153.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 9356.43, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 9356.43, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10396.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6950.94 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 10396.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 9524.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9524.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 10396.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 7797.02, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16148, "minimum": 11303.824, "maximum": 28259.56, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15663.87, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28259.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15059.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 12833.47 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14622.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16148.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14622.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15061.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14622.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16148.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11303.82, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16148.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15825.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 20992.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 20992.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15499.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19009.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25029.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15353.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15353.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22664.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 25837.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 25589.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16148.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16148.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12918.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12918.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15353.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14129.78, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 20992.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14622.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14622.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 26644.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14533.49, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14533.49, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16148.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15996.1 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16148.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14622.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14622.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16148.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12111.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4209) 5+ Cc Sterile Syringe&Needle", "code_information": [ { "code": "A4209", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "median_amount": 1.31, "10th_percentile": 1.31, "90th_percentile": 1.91, "count": "1 through 10" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13703, "minimum": 9592.429, "maximum": 23981.0725, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13292.37, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23981.07, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13153.54 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 11209.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 12455.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 13703.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12455.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 12829.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 12455.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13703.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9592.43, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13703.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 13429.4, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 17814.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 17814.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13203.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 16192.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21240.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13078.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13078.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19306.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 21925.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 21797.48, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 13703.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13703.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 10962.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10962.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 13078.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 11990.54, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 17814.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 12455.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12455.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 22610.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 12333.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 12333.12, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13703.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13951 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 13703.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 12455.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12455.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 13703.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 10277.6, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4212) Non Coring Needle Or Stylet", "code_information": [ { "code": "A4212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "median_amount": 5.01, "10th_percentile": 5.01, "90th_percentile": 5.01, "count": "1 through 10" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21649, "minimum": 3440.03, "maximum": 37887.2725, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21000.37, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 37887.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 19498.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 21649.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19498.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 20083.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 19498.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21649.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15154.91, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21649.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 21216.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 28144.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 28144.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20668.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 25347.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33557.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20473.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20473.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30222.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 34639.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 21649.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21649.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 17319.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17319.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 20473.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 18943.64, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 28144.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 19498.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19498.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 35722.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 19484.88, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 19484.88, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21649.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3440.03 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 21649.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 19498.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19498.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 21649.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 16237.4, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Ankle Joint Open", "code_information": [ { "code": "27870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55024.4, "discounted_cash": 12833, "minimum": 1500, "maximum": 53923.912, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12448.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25667.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13923.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13209.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15470.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15470.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13219, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 19250.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8983.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 12577.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17967.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22459.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 11229.73, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 16042.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 9625.49, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Foot Bones - 28730 - OR36028730", "code_information": [ { "code": "28730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112500, "discounted_cash": 12833, "minimum": 1500, "maximum": 110250, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12448.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25667.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13923.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 13209.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15470.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15470.92 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13219, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 19250.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8983.79, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 12577.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17967.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16684.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22459.47, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10267.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 13475.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 11229.73, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 16042.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 11550.58, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 12833.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 9625.49, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16204, "minimum": 11343.353, "maximum": 28358.3825, "payers_information": [ { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 25676.88, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 16204.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16204.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 12963.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12963.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 15406.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 14179.19, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 21066.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 14672.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14672.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 26737.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 14584.31, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 14584.31, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14686.3 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 16204.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 14672.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14672.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16204.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 12153.59, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15718.65, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28358.38, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16620.5 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 14163.52 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 14672.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 16204.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14672.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 15112.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 14672.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 16204.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11343.35, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16204.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 15880.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 21066.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 21066.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15552.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 19074.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25117.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15406.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15406.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22742.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 25927.66, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19542, "minimum": 13679.526, "maximum": 34198.815, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18955.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 34198.82, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19123.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 16296.67 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 17630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 19542.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 18159.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 17630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19542.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13679.53, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19542.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 19151.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 25404.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 25404.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18688.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 22919.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30290.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18511.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18511.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27326.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 31267.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 30853.03, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 19542.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19542.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 15633.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15633.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 18511.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 17099.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 25404.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 17630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 32244.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 17587.96, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 17587.96, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19542.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17595.2 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 19542.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 17630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17630.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 19542.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 14656.64, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11125, "minimum": 7787.584, "maximum": 19468.96, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10791.37, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19468.96, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10588.51 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 9023.22 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 10170.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "case rate", "standard_charge_dollar": 11125.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10170.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "case rate", "standard_charge_dollar": 10475.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "case rate", "standard_charge_dollar": 10170.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11125.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7787.58, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11125.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "case rate", "standard_charge_dollar": 10902.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "case rate", "standard_charge_dollar": 14462.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "case rate", "standard_charge_dollar": 14462.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10780.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "case rate", "standard_charge_dollar": 13221.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17243.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10679.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10679.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15764.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "plan_name": "NHSI AND IMS Commercial", "methodology": "case rate", "standard_charge_dollar": 17800.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "case rate", "standard_charge_dollar": 17798.55, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "case rate", "standard_charge_dollar": 11125.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11125.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "case rate", "standard_charge_dollar": 8900.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8900.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "case rate", "standard_charge_dollar": 10679.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "case rate", "standard_charge_dollar": 9734.48, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "case rate", "standard_charge_dollar": 14462.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "case rate", "standard_charge_dollar": 10170.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10170.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "case rate", "standard_charge_dollar": 18356.45, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "case rate", "standard_charge_dollar": 10012.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "case rate", "standard_charge_dollar": 10012.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11125.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8265.51 }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "case rate", "standard_charge_dollar": 11125.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "case rate", "standard_charge_dollar": 10170.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10170.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "case rate", "standard_charge_dollar": 11125.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "case rate", "standard_charge_dollar": 8343.84, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Peripheral Arterial Disease Rehab Per Session", "code_information": [ { "code": "93668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.25, "discounted_cash": 58, "minimum": 16.3728, "maximum": 278.565, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 117.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.05 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 58.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 88.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 47.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 51.6, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 53.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 53.07, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 44.23, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4213) 20+ Cc Syringe Only", "code_information": [ { "code": "A4213", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.85, "10th_percentile": 0.49, "90th_percentile": 2.86, "count": "26" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 2.08, "10th_percentile": 2.08, "90th_percentile": 2.23, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 2.92, "10th_percentile": 2.92, "90th_percentile": 2.92, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.24, "10th_percentile": 0.61, "90th_percentile": 3.11, "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": 5.76, "median_amount": 0.95, "10th_percentile": 0.8, "90th_percentile": 1.89, "count": "14" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.17, "10th_percentile": 0.99, "90th_percentile": 2.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.58, "10th_percentile": 0.49, "90th_percentile": 2.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.09, "10th_percentile": 1.09, "90th_percentile": 1.09, "count": "1 through 10" }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 65, "median_amount": 1.03, "10th_percentile": 1.03, "90th_percentile": 1.03, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "median_amount": 3.81, "10th_percentile": 0.58, "90th_percentile": 4.59, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4215) Sterile Needle", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 65, "median_amount": 0.17, "10th_percentile": 0.17, "90th_percentile": 0.17, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.95, "count": "1 through 10" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.58, "10th_percentile": 0.49, "90th_percentile": 1.46, "count": "39" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1, "10th_percentile": 0.49, "90th_percentile": 1.93, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 13.32, "10th_percentile": 13.32, "90th_percentile": 13.32, "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": 5.76, "median_amount": 0.44, "10th_percentile": 0.38, "90th_percentile": 0.75, "count": "32" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.93, "10th_percentile": 0.93, "90th_percentile": 1.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.58, "10th_percentile": 0.49, "90th_percentile": 1.14, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.27, "10th_percentile": 0.27, "90th_percentile": 0.49, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4314) Cath W/Drainage 2-Way Latex", "code_information": [ { "code": "A4314", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "median_amount": 19.67, "10th_percentile": 19.67, "90th_percentile": 28.61, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4649) Surgical Supplies - A4649 - RU272005", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8, "median_amount": 660.13, "10th_percentile": 15.09, "90th_percentile": 1715.66, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4402) Lubricant Per Ounce", "code_information": [ { "code": "A4402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.22, "10th_percentile": 0.58, "90th_percentile": 2.3, "count": "39" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.76, "10th_percentile": 0.61, "90th_percentile": 3.53, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.32, "10th_percentile": 1.32, "90th_percentile": 2.48, "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": 5.76, "median_amount": 2.93, "10th_percentile": 2.93, "90th_percentile": 8.8, "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": 5.76, "median_amount": 3.09, "10th_percentile": 3.09, "90th_percentile": 3.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.22, "10th_percentile": 0.58, "90th_percentile": 3.44, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - 27200146", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.58, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.18, "10th_percentile": 1.18, "90th_percentile": 1.18, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6402) Sterile Gauze <= 16 Sq In - A6402 - RU272059", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 1.07, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.48, "10th_percentile": 1.48, "90th_percentile": 1.48, "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": 5.76, "median_amount": 0.24, "10th_percentile": 0.24, "90th_percentile": 0.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.33, "10th_percentile": 0.33, "90th_percentile": 0.33, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A5200) Percutaneous Catheter Anchor", "code_information": [ { "code": "A5200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.35, "10th_percentile": 1.31, "90th_percentile": 4.13, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.48, "10th_percentile": 1.48, "90th_percentile": 1.48, "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": 5.76, "median_amount": 20.79, "10th_percentile": 20.79, "90th_percentile": 20.79, "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": 5.76, "median_amount": 21.86, "10th_percentile": 21.86, "90th_percentile": 21.86, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - RU272058", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.58, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.18, "10th_percentile": 1.18, "90th_percentile": 1.18, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.61, "10th_percentile": 0.61, "90th_percentile": 0.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 0.58, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1750) Cathhemodial/Peritonlong-Term", "code_information": [ { "code": "C1750", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 395.24, "10th_percentile": 395.24, "90th_percentile": 395.24, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1765) Adhesion Barrier", "code_information": [ { "code": "C1765", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 384.57, "10th_percentile": 384.57, "90th_percentile": 384.57, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6402) Sterile Gauze <= 16 Sq In - A6402 - 27200152", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.58, "10th_percentile": 0.58, "90th_percentile": 1.07, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 1.48, "10th_percentile": 1.48, "90th_percentile": 1.48, "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": 5.76, "median_amount": 0.24, "10th_percentile": 0.24, "90th_percentile": 0.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 0.33, "10th_percentile": 0.33, "90th_percentile": 0.33, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1755) Catheter Intraspinal", "code_information": [ { "code": "C1755", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 38.75, "10th_percentile": 38.75, "90th_percentile": 45.61, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 46.94, "10th_percentile": 46.94, "90th_percentile": 46.94, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6457) Tubular Dressing - A6457 - RU272066", "code_information": [ { "code": "A6457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 2.74, "10th_percentile": 2.74, "90th_percentile": 2.74, "count": "1 through 10" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - 93307 - 48300011", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1551.83, "discounted_cash": 238, "minimum": 135.33, "maximum": 1520.7934, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 477.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 261.19 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 283.09 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 349.99 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 314.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 314.12 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 245.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.02 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 357.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 166.96, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 233.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.02 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 310.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.45 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 369.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 250.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.86 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.2 }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.39, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 190.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 190.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 250.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 208.7, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 310.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 253.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 261.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.72 }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 393.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 298.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 214.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 214.66, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 136.66 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 255.55 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.42 }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 238.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 178.88, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - C8923 - 48300011", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1551.83, "discounted_cash": 783, "minimum": 89.3854, "maximum": 1551.83, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 760.12, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1551.83, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 807.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1175.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 548.54, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 767.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1097.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1018.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 830.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1018.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1214.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 822.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 822.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1214.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1371.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 626.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 822.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 685.68, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1018.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 1292.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 979.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 705.27, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 705.27, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 783.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 587.72, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4230.16, "discounted_cash": 906, "minimum": 243.6572, "maximum": 4145.5568, "payers_information": [ { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 793.32, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 1133.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 815.99, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 815.99, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 679.99, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 879.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1813.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 919.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 872.37 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1021.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1021.7 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 933.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 1359.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 634.66, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 888.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1269.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1405.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.64, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 725.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 725.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 951.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholine Receptor Binding Antibody", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.14, "discounted_cash": 18, "minimum": 12.88, "maximum": 96.14, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 66.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.73 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.73 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "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 MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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 - Medicare/MMP", "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 CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.91 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.38 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.5, "discounted_cash": 15, "minimum": 10.724, "maximum": 187.67, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 44.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 55.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.64 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 49.64 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.58 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.58 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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 - Medicare/MMP", "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 CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.13 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Blckg Antb", "code_information": [ { "code": "86042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.14, "discounted_cash": 18, "minimum": 12.88, "maximum": 96.14, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.73 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 66.42 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.73 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.73 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "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 MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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 - Medicare/MMP", "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 CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.91 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.38 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acylcarnitines Quant", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.4, "discounted_cash": 16, "minimum": 11.809, "maximum": 208.152, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.26 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 60.9 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.17 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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 - Medicare/MMP", "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 CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Modlg Antb", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.96, "discounted_cash": 12, "minimum": 8.435, "maximum": 62.96, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.19 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.12 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.12 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.49 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 10.54, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.92 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Agglutinins; Febrile", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.11, "discounted_cash": 6, "minimum": 4.886, "maximum": 161.8078, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.38 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.61 }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 10.96 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 11.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.31 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Actin Smooth Muscle Antibody Each", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.25, "discounted_cash": 12, "minimum": 8.435, "maximum": 60.25, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.67 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.36 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 37.36 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.12 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.12 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.49 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 10.54, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.92 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.81, "discounted_cash": 14, "minimum": 10.122, "maximum": 75.81, "payers_information": [ { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.22 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.2 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.85 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.85 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.15 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.15 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.4 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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 - Medicare/MMP", "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 CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.66 } ] } ] }, { "description": "Hc Aep Scr Auditory Potential W/Stimuli Auto Alys", "code_information": [ { "code": "92650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.6, "minimum": 15.7594, "maximum": 268.128, "payers_information": [ { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 89.44 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 110.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.24 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 99.24 } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 608.19, "discounted_cash": 13, "minimum": 9.408, "maximum": 596.0262, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.24 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 48.52 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.55 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 13.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.97 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.11 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1001.11, "discounted_cash": 218, "minimum": 57.6639, "maximum": 981.0878, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.32, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 437.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 90.5, "10th_percentile": 90.5, "90th_percentile": 90.5, "count": "1 through 10" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 537.16 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 664.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 596.03 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 596.03 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 225.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 328.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.22, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 214.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 97.4, "10th_percentile": 59.37, "90th_percentile": 114.62, "count": "11" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 284.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 117.98, "10th_percentile": 117.98, "90th_percentile": 117.98, "count": "1 through 10" }, { "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 95.92, "10th_percentile": 95.92, "90th_percentile": 95.92, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 124.09, "10th_percentile": 117.98, "90th_percentile": 146.1, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 339.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.06, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 175.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 191.53, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "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 CHIP Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 57.66, "10th_percentile": 57.66, "90th_percentile": 57.66, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 94.56, "10th_percentile": 55.18, "90th_percentile": 115.33, "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": 5.76, "median_amount": 117.05, "10th_percentile": 117.05, "90th_percentile": 137.81, "count": "12" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 273.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 197, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 197, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.76, "median_amount": 97.37, "10th_percentile": 97.37, "90th_percentile": 97.37, "count": "1 through 10" }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 218.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 164.17, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.54, "discounted_cash": 64, "minimum": 45.087, "maximum": 329.8092, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 188.08 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.52 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 208.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.09, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 63.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.55 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.35 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.68 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.41 }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.72, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 51.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 56.36, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 83.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 101.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.82 }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 106.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 80.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 57.97, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 57.97, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.82 }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.86, "discounted_cash": 5, "minimum": 3.654, "maximum": 112.86, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.24 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.84 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.91 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.91 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.71 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.65, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.71 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Multiple Qual", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360, "discounted_cash": 13, "minimum": 9.709, "maximum": 352.8, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.5 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.07 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 44.94 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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 - Medicare/MMP", "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 CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.65 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allg Test Perq & Ic Drug/Biol Immed React W/I&R", "code_information": [ { "code": "95018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.2, "discounted_cash": 37, "minimum": 9.7459, "maximum": 165.816, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.22, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 74.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 97.62 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 120.68 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 108.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.14, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 36.59, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Magic Valley Electric Cooperative", "plan_name": "Magic Valley Electric Cooperative Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.35, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 39.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 32.67, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "methodology": "fee schedule", "standard_charge_dollar": 48.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan - Medicare/MMP", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnett Health Plan HMO PPO EPO", "methodology": "fee schedule", "standard_charge_dollar": 61.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 46.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 33.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 33.61, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Veterans Evaluation Services", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellmed AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 28.01, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13116.7, "discounted_cash": 3270, "minimum": 755.5219, "maximum": 12854.366, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3172.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6541.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3202.82 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3038.57 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3558.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3368.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4906.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2289.56, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4579.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4252.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "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 MMP Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5069.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5723.9, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2616.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3434.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2861.95, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 4088.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2943.72, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3270.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2453.1, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, 6+ Quant", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.17, "discounted_cash": 16, "minimum": 11.809, "maximum": 312.7866, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.26 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 60.9 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.17 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.52, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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 - Medicare/MMP", "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 CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128, "discounted_cash": 22, "minimum": 16.086, "maximum": 128, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.22, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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 - Medicare/MMP", "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 CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 28.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 45.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 67.1 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 82.96 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.46 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 74.46 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.37 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.37 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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 } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14952.2, "discounted_cash": 3156, "minimum": 163.05, "maximum": 14653.156, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8092.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10004.32 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8978.95 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8978.95 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.13 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2209.42, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3093.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.13 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.83 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5523.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2525.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2525.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2761.78, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2840.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2840.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 163.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.99 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2367.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniotic Fluid Scan", "code_information": [ { "code": "82143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135, "discounted_cash": 9, "minimum": 6.545, "maximum": 135, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.15 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.75 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.29 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 30.29 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.61 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.61 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 8.18, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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 - Medicare/MMP", "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 CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "90.00% 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": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.94 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Spinal Selectv", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21882.6, "discounted_cash": 5562, "minimum": 175, "maximum": 21444.948, "payers_information": [ { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 498.84 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3893.72, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5451.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 498.84 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 483.34 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7231.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 266 }, { "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 MMP Medicare Advantage", "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": 513.37 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 539.97 }, { "payer_name": "Multiplan", "plan_name": "Multiplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8621.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9734.29, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4449.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 5840.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 4867.14, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 469.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 509.41 }, { "payer_name": "Texas Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 6953.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 5006.21, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 250.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 469.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.31 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 509.41 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 4171.84, "additional_payer_notes": "75.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.31 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13420.87 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16592.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14891.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14891.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13207.6, "discounted_cash": 3156, "minimum": 172.75, "maximum": 12943.448, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6312.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8092.14 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10004.32 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8978.95 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8978.95 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 3251.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 4734.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2209.42, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 3093.19, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.41 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4418.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4103.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.12 }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina MMP Medicare Advantage", "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": "Multiplan", "plan_name": "Multiplan Medicare", "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": "OccuNet", "plan_name": "OccuNet - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5523.56, "additional_payer_notes": "175.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Auto", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Auto", "methodology": "fee schedule", "standard_charge_dollar": 2525.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2525.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "PROVIDER PARTNERS HEALTH PLAN MEDICARE", "methodology": "fee schedule", "standard_charge_dollar": 3314.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT WC", "methodology": "fee schedule", "standard_charge_dollar": 2761.78, "additional_payer_notes": "87.50% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Commercial Exchange HMO EPO", "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/MMP", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan CHIP Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "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 Bluebonnet Health Plan", "plan_name": "Texas Bluebonnet Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Texas Bluebonnet 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 Oncology PA OP", "plan_name": "Texas Oncology, Pa Outpatient Only", "methodology": "fee schedule", "standard_charge_dollar": 3945.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS Auto", "methodology": "fee schedule", "standard_charge_dollar": 2840.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "THREE RIVERS WC", "methodology": "fee schedule", "standard_charge_dollar": 2840.69, "additional_payer_notes": "90.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest - BCBS", "plan_name": "Triwest - BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC CHIP MEDICAID", "methodology": "fee schedule", "standard_charge_dollar": 172.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare Advantage - 100%", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR KIDS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.68 }, { "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 AARP MA FKA Physicians Health Choice", "plan_name": "Wellmed AARP - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 3156.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare Auto", "methodology": "fee schedule", "standard_charge_dollar": 2367.24, "additional_payer_notes": "75.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24228.7, "discounted_cash": 5562, "minimum": 170.08, "maximum": 23744.126, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN)", "plan_name": "Americas Choice Provider Network ACPN Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5395.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BAKER BENEFITS ADMINISTRATORS", "plan_name": "BAKER BENEFITS ADMINISTRATORS COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11124.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 328.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13420.87 }, { "payer_name": "BCBS TX", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16592.25 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Medicare Advantage HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS TX", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14891.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14891.66 }, { "payer_name": "BCBS TX", "plan_name": "BCBS TriWest", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "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", "plan_name": "Cigna Healthspring - Medicare Advantage PPO", "methodology": "fee schedule", "standard_charge_dollar": 5729.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring - MMP Dual", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring Medicaid", "plan_name": "Cigna HealthSpring Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.1 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Worker Comp", "methodology": "fee schedule", "standard_charge_dollar": 8343.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3893.72, "additional_payer_notes": "70.00% of Medicare Rates" }, { "payer_name": "Coventry (FIRST HEALTH)", "plan_name": "Coventry First Health Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Division of Immigration Health", "plan_name": "Division of Immigration Health", "methodology": "fee schedule", "standard_charge_dollar": 5451.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.1 }, { "payer_name": "Driscoll Health Plan Medicaid", "plan_name": "Driscoll Star Kids Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.59 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7787.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FRONTIER HEALTH (FKA Asserta Health)", "plan_name": "FRONTIER HEALTH (FKA Asserta Health) Commercial",