{ "hospital_name": "Strategic BH-Brownsville, LLC", "last_updated_on": "2026-05-20", "version": "3.0.0", "location_name": [ "Palms Behavioral Health" ], "hospital_address": [ "613 Victoria Lane, Harlingen, TX 78550" ], "license_information": { "state": "TX", "license_number": "140" }, "type_2_npi": [ "1154782548" ], "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": "Cynthia Mendoza" }, "standard_charge_information": [ { "description": "Bridge Services", "code_information": [ { "code": "H0032", "type": "HCPCS" }, { "code": "44000", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 49.0, "methodology": "fee schedule" } ], "minimum": 49.0, "maximum": 49.0 } ] }, { "description": "Acute Adol R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "5003", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 982.0, "methodology": "fee schedule" }, { "payer_name": "All Savers/UHC Network", "plan_name": "All Savers/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Medicare", "plan_name": "Anthem BCBS Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefits Administrators/IMS PPO", "plan_name": "Assured Benefits Administrators/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 910.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "BCFS/PCU", "plan_name": "BCFS/PCU", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Mcaid", "plan_name": "Beacon Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Blue Cross Community Health Plan", "plan_name": "Blue Cross Community Health Plan", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Border Region", "plan_name": "Border Region", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Christus Health Plan- Commercial", "plan_name": "Christus Health Plan- Commercial", "standard_charge_dollar": 940.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 984.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 937.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcaid", "plan_name": "Cigna Healthspring- Mcaid", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Coastal Plains", "plan_name": "Coastal Plains", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Community First - Mcaid", "plan_name": "Community First - Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Community Health Choice- MCD", "plan_name": "Community Health Choice- MCD", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Compass Connect", "plan_name": "Compass Connect", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits/IMS PPO", "plan_name": "Continental Benefits/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "Corpus Christi State Support Living Cent", "plan_name": "Corpus Christi State Support Living Cent", "standard_charge_dollar": 529.9, "methodology": "fee schedule" }, { "payer_name": "CSHCN Services Program - Texas Medicaid", "plan_name": "CSHCN Services Program - Texas Medicaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "DFPS", "plan_name": "DFPS", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 794.39, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan STAR Kids", "plan_name": "Driscoll Health Plan STAR Kids", "standard_charge_dollar": 786.44, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Friday Health Plans", "plan_name": "Friday Health Plans", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "GEHA/UHC Network", "plan_name": "GEHA/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Hands Of Healing", "plan_name": "Hands Of Healing", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 927.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360", "plan_name": "Imagine 360", "standard_charge_dollar": 869.5, "methodology": "fee schedule" }, { "payer_name": "KAISER PERMANENTE", "plan_name": "KAISER PERMANENTE", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "LA Medicaid - UHC", "plan_name": "LA Medicaid - UHC", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mayo Medical Plan", "plan_name": "Mayo Medical Plan", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "MHNET", "plan_name": "MHNET", "standard_charge_dollar": 1100.0, "methodology": "fee schedule" }, { "payer_name": "MHNET Medicare Advtg", "plan_name": "MHNET Medicare Advtg", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Commerical", "plan_name": "Molina Healthcare-Commerical", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Montana Access Health", "plan_name": "Montana Access Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mutual Of Omaha", "plan_name": "Mutual Of Omaha", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Nueces Center MHID", "plan_name": "Nueces Center MHID", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Optima Health", "plan_name": "Optima Health", "standard_charge_dollar": 1104.5, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Pan American Life", "plan_name": "Pan American Life", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Port Isabel", "plan_name": "Port Isabel", "standard_charge_dollar": 825.0, "methodology": "fee schedule" }, { "payer_name": "Professional Benefit Administrators", "plan_name": "Professional Benefit Administrators", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Right Care From Scott & White - Medicaid", "plan_name": "Right Care From Scott & White - Medicaid", "standard_charge_dollar": 1550.0, "methodology": "fee schedule" }, { "payer_name": "Serving Children And Adults In Need, INC", "plan_name": "Serving Children And Adults In Need, INC", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", "standard_charge_dollar": 869.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare For Life", "plan_name": "Tricare For Life", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 1009.85, "methodology": "fee schedule" }, { "payer_name": "TriWest WPS-VA", "plan_name": "TriWest WPS-VA", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Tropical Texas", "plan_name": "Tropical Texas", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "TTBH-UFUR", "plan_name": "TTBH-UFUR", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "UCT", "plan_name": "UCT", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "UHC United Shared Services", "plan_name": "UHC United Shared Services", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "United Health One", "plan_name": "United Health One", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 670.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Urban Strategies", "plan_name": "Urban Strategies", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Medicaid", "plan_name": "Wellpoint Medicaid", "standard_charge_dollar": 750.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 500.0, "maximum": 1550.0 } ] }, { "description": "Acute Adult R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "5001", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 982.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1011.0, "methodology": "fee schedule" }, { "payer_name": "All Savers/UHC Network", "plan_name": "All Savers/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Medicare", "plan_name": "Anthem BCBS Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefits Administrators/IMS PPO", "plan_name": "Assured Benefits Administrators/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicaid", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Mcaid", "plan_name": "Beacon Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Blue Cross Community Health Plan", "plan_name": "Blue Cross Community Health Plan", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Boon Chapman", "plan_name": "Boon Chapman", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "Border Region", "plan_name": "Border Region", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Christus Health Plan- Commercial", "plan_name": "Christus Health Plan- Commercial", "standard_charge_dollar": 940.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 984.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 937.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcaid", "plan_name": "Cigna Healthspring- Mcaid", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Coastal Plains", "plan_name": "Coastal Plains", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Community First - Mcaid", "plan_name": "Community First - Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Community Health Choice- MCD", "plan_name": "Community Health Choice- MCD", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Compass Connect", "plan_name": "Compass Connect", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits/IMS PPO", "plan_name": "Continental Benefits/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "Corpus Christi State Support Living Cent", "plan_name": "Corpus Christi State Support Living Cent", "standard_charge_dollar": 529.9, "methodology": "fee schedule" }, { "payer_name": "CSHCN Services Program - Texas Medicaid", "plan_name": "CSHCN Services Program - Texas Medicaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "DFPS", "plan_name": "DFPS", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 794.39, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan STAR Kids", "plan_name": "Driscoll Health Plan STAR Kids", "standard_charge_dollar": 786.44, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Friday Health Plans", "plan_name": "Friday Health Plans", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "GEHA/UHC Network", "plan_name": "GEHA/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Hands Of Healing", "plan_name": "Hands Of Healing", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 927.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360", "plan_name": "Imagine 360", "standard_charge_dollar": 869.5, "methodology": "fee schedule" }, { "payer_name": "Immigration Health Services", "plan_name": "Immigration Health Services", "standard_charge_dollar": 785.0, "methodology": "fee schedule" }, { "payer_name": "KAISER PERMANENTE", "plan_name": "KAISER PERMANENTE", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "LA Medicaid - UHC", "plan_name": "LA Medicaid - UHC", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mayo Medical Plan", "plan_name": "Mayo Medical Plan", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "MHNET", "plan_name": "MHNET", "standard_charge_dollar": 1100.0, "methodology": "fee schedule" }, { "payer_name": "MHNET Medicare Advtg", "plan_name": "MHNET Medicare Advtg", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Commerical", "plan_name": "Molina Healthcare-Commerical", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Montana Access Health", "plan_name": "Montana Access Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mutual Of Omaha", "plan_name": "Mutual Of Omaha", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Nueces Center MHID", "plan_name": "Nueces Center MHID", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Pan American Life", "plan_name": "Pan American Life", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Port Isabel", "plan_name": "Port Isabel", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Professional Benefit Administrators", "plan_name": "Professional Benefit Administrators", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Right Care From Scott & White - Medicaid", "plan_name": "Right Care From Scott & White - Medicaid", "standard_charge_dollar": 1550.0, "methodology": "fee schedule" }, { "payer_name": "Serving Children And Adults In Need, INC", "plan_name": "Serving Children And Adults In Need, INC", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", "standard_charge_dollar": 869.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare For Life", "plan_name": "Tricare For Life", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 1009.85, "methodology": "fee schedule" }, { "payer_name": "TriWest WPS-VA", "plan_name": "TriWest WPS-VA", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Tropical Texas", "plan_name": "Tropical Texas", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "TTBH-UFUR", "plan_name": "TTBH-UFUR", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "UCT", "plan_name": "UCT", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "UHC United Shared Services", "plan_name": "UHC United Shared Services", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "United Health One", "plan_name": "United Health One", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 670.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "WELLCARE BY ALLWELL", "plan_name": "WELLCARE BY ALLWELL", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Mcare Advtg", "plan_name": "Wellcare Mcare Advtg", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Medicaid", "plan_name": "Wellpoint Medicaid", "standard_charge_dollar": 750.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 500.0, "maximum": 1550.0 } ] }, { "description": "Acute Child R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "41100", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Anthem BCBS Medicare", "plan_name": "Anthem BCBS Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefits Administrators/IMS PPO", "plan_name": "Assured Benefits Administrators/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 910.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Mcaid", "plan_name": "Beacon Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Border Region", "plan_name": "Border Region", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 984.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 937.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcaid", "plan_name": "Cigna Healthspring- Mcaid", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Coastal Plains", "plan_name": "Coastal Plains", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Community First - Mcaid", "plan_name": "Community First - Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Community Health Choice- MCD", "plan_name": "Community Health Choice- MCD", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits/IMS PPO", "plan_name": "Continental Benefits/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "DFPS", "plan_name": "DFPS", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 794.39, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan STAR Kids", "plan_name": "Driscoll Health Plan STAR Kids", "standard_charge_dollar": 786.44, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "GEHA/UHC Network", "plan_name": "GEHA/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Hands Of Healing", "plan_name": "Hands Of Healing", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 927.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360", "plan_name": "Imagine 360", "standard_charge_dollar": 869.5, "methodology": "fee schedule" }, { "payer_name": "KAISER PERMANENTE", "plan_name": "KAISER PERMANENTE", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Mayo Medical Plan", "plan_name": "Mayo Medical Plan", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "MHNET Medicare Advtg", "plan_name": "MHNET Medicare Advtg", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Commerical", "plan_name": "Molina Healthcare-Commerical", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Mutual Of Omaha", "plan_name": "Mutual Of Omaha", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Nueces Center MHID", "plan_name": "Nueces Center MHID", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Pan American Life", "plan_name": "Pan American Life", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Port Isabel", "plan_name": "Port Isabel", "standard_charge_dollar": 825.0, "methodology": "fee schedule" }, { "payer_name": "Professional Benefit Administrators", "plan_name": "Professional Benefit Administrators", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 1009.85, "methodology": "fee schedule" }, { "payer_name": "Tropical Texas", "plan_name": "Tropical Texas", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "TTBH-UFUR", "plan_name": "TTBH-UFUR", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "UCT", "plan_name": "UCT", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "UHC United Shared Services", "plan_name": "UHC United Shared Services", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "United Health One", "plan_name": "United Health One", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 670.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Medicaid", "plan_name": "Wellpoint Medicaid", "standard_charge_dollar": 750.0, "methodology": "fee schedule" } ], "gross_charge": 2600.0, "discounted_cash": 650.0, "minimum": 529.59, "maximum": 1150.0 } ] }, { "description": "Acute Gero R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "5000", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 982.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1011.0, "methodology": "fee schedule" }, { "payer_name": "All Savers/UHC Network", "plan_name": "All Savers/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Medicare", "plan_name": "Anthem BCBS Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefits Administrators/IMS PPO", "plan_name": "Assured Benefits Administrators/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Mcaid", "plan_name": "Beacon Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Blue Cross Community Health Plan", "plan_name": "Blue Cross Community Health Plan", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Boon Chapman", "plan_name": "Boon Chapman", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "Border Region", "plan_name": "Border Region", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Christus Health Plan- Commercial", "plan_name": "Christus Health Plan- Commercial", "standard_charge_dollar": 940.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 984.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 937.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcaid", "plan_name": "Cigna Healthspring- Mcaid", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Coastal Plains", "plan_name": "Coastal Plains", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Community First - Mcaid", "plan_name": "Community First - Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Community Health Choice- MCD", "plan_name": "Community Health Choice- MCD", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Compass Connect", "plan_name": "Compass Connect", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits/IMS PPO", "plan_name": "Continental Benefits/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "Corpus Christi State Support Living Cent", "plan_name": "Corpus Christi State Support Living Cent", "standard_charge_dollar": 529.9, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "DFPS", "plan_name": "DFPS", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 794.39, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Friday Health Plans", "plan_name": "Friday Health Plans", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "GEHA/UHC Network", "plan_name": "GEHA/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Hands Of Healing", "plan_name": "Hands Of Healing", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 927.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360", "plan_name": "Imagine 360", "standard_charge_dollar": 869.5, "methodology": "fee schedule" }, { "payer_name": "KAISER PERMANENTE", "plan_name": "KAISER PERMANENTE", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "LA Medicaid - UHC", "plan_name": "LA Medicaid - UHC", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mayo Medical Plan", "plan_name": "Mayo Medical Plan", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "MHNET", "plan_name": "MHNET", "standard_charge_dollar": 1100.0, "methodology": "fee schedule" }, { "payer_name": "MHNET Medicare Advtg", "plan_name": "MHNET Medicare Advtg", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Commerical", "plan_name": "Molina Healthcare-Commerical", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Montana Access Health", "plan_name": "Montana Access Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mutual Of Omaha", "plan_name": "Mutual Of Omaha", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Nueces Center MHID", "plan_name": "Nueces Center MHID", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Pan American Life", "plan_name": "Pan American Life", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Port Isabel", "plan_name": "Port Isabel", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Professional Benefit Administrators", "plan_name": "Professional Benefit Administrators", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Right Care From Scott & White - Medicaid", "plan_name": "Right Care From Scott & White - Medicaid", "standard_charge_dollar": 1550.0, "methodology": "fee schedule" }, { "payer_name": "Serving Children And Adults In Need, INC", "plan_name": "Serving Children And Adults In Need, INC", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", "standard_charge_dollar": 869.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare For Life", "plan_name": "Tricare For Life", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 1009.85, "methodology": "fee schedule" }, { "payer_name": "TriWest WPS-VA", "plan_name": "TriWest WPS-VA", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Tropical Texas", "plan_name": "Tropical Texas", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "TTBH-UFUR", "plan_name": "TTBH-UFUR", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "UCT", "plan_name": "UCT", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "UHC United Shared Services", "plan_name": "UHC United Shared Services", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "United Health One", "plan_name": "United Health One", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 670.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Mcare Advtg", "plan_name": "Wellcare Mcare Advtg", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Medicaid", "plan_name": "Wellpoint Medicaid", "standard_charge_dollar": 750.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 500.0, "maximum": 1550.0 } ] }, { "description": "Acute Adol CD R&B", "code_information": [ { "code": "126", "type": "RC" }, { "code": "41119", "type": "LOCAL" } ], "standard_charges": 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750.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Mcaid", "plan_name": "Beacon Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Boon Chapman", "plan_name": "Boon Chapman", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "Border Region", "plan_name": "Border Region", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Christus Health Plan- Commercial", "plan_name": "Christus Health Plan- Commercial", "standard_charge_dollar": 940.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 984.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 937.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcaid", "plan_name": "Cigna Healthspring- Mcaid", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Coastal Plains", "plan_name": "Coastal Plains", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Community First - Mcaid", "plan_name": "Community First - Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Compass Connect", "plan_name": "Compass Connect", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits/IMS PPO", "plan_name": "Continental Benefits/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "DFPS", "plan_name": "DFPS", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 794.39, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan STAR Kids", "plan_name": "Driscoll Health Plan STAR Kids", "standard_charge_dollar": 786.44, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "GEHA/UHC Network", "plan_name": "GEHA/UHC Network", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Hands Of Healing", "plan_name": "Hands Of Healing", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 927.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360", "plan_name": "Imagine 360", "standard_charge_dollar": 869.5, "methodology": "fee schedule" }, { "payer_name": "Mayo Medical Plan", "plan_name": "Mayo Medical Plan", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "MHNET", "plan_name": "MHNET", "standard_charge_dollar": 1100.0, "methodology": "fee schedule" }, { "payer_name": "MHNET Medicare Advtg", "plan_name": "MHNET Medicare Advtg", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Commerical", "plan_name": "Molina Healthcare-Commerical", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Montana Access Health", "plan_name": "Montana Access Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mutual Of Omaha", "plan_name": "Mutual Of Omaha", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Nueces Center MHID", "plan_name": "Nueces Center MHID", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Optima Health", "plan_name": "Optima Health", "standard_charge_dollar": 1104.5, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Pan American Life", "plan_name": "Pan American Life", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Port Isabel", "plan_name": "Port Isabel", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Professional Benefit Administrators", "plan_name": "Professional Benefit Administrators", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Right Care From Scott & White - Medicaid", "plan_name": "Right Care From Scott & White - Medicaid", "standard_charge_dollar": 1550.0, "methodology": "fee schedule" }, { "payer_name": "Serving Children And Adults In Need, INC", "plan_name": "Serving Children And Adults In Need, INC", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare For Life", "plan_name": "Tricare For Life", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 1009.85, "methodology": "fee schedule" }, { "payer_name": "Tropical Texas", "plan_name": "Tropical Texas", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "UCT", "plan_name": "UCT", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "UHC United Shared Services", "plan_name": "UHC United Shared Services", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "United Health One", "plan_name": "United Health One", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 670.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Medicaid", "plan_name": "Wellpoint Medicaid", "standard_charge_dollar": 750.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 500.0, "maximum": 1550.0 } ] }, { "description": "Acute Adult CD R&B", "code_information": [ { "code": "126", "type": "RC" }, { "code": "41120", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 982.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1011.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Medicare", "plan_name": "Anthem BCBS Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefits Administrators/IMS PPO", "plan_name": "Assured Benefits Administrators/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Mcaid", "plan_name": "Beacon Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Boon Chapman", "plan_name": "Boon Chapman", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "Border Region", "plan_name": "Border Region", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Christus Health Plan- Commercial", "plan_name": "Christus Health Plan- Commercial", "standard_charge_dollar": 940.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 984.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 937.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcaid", "plan_name": "Cigna Healthspring- Mcaid", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Coastal Plains", "plan_name": "Coastal Plains", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Community First - Mcaid", "plan_name": "Community First - Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Compass Connect", "plan_name": "Compass Connect", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits/IMS PPO", "plan_name": "Continental Benefits/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "Corpus Christi State Support Living Cent", "plan_name": "Corpus Christi State Support Living Cent", "standard_charge_dollar": 529.9, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "DFPS", "plan_name": "DFPS", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 794.39, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan STAR Kids", "plan_name": "Driscoll Health Plan STAR Kids", "standard_charge_dollar": 786.44, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Friday Health Plans", "plan_name": "Friday Health Plans", "standard_charge_dollar": 1000.0, "methodology": "fee schedule" }, { "payer_name": "GEHA/UHC Network", "plan_name": "GEHA/UHC Network", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Hands Of Healing", "plan_name": "Hands Of Healing", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 927.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360", "plan_name": "Imagine 360", "standard_charge_dollar": 869.5, "methodology": "fee schedule" }, { "payer_name": "LA Medicaid - UHC", "plan_name": "LA Medicaid - UHC", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mayo Medical Plan", "plan_name": "Mayo Medical Plan", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "MHNET", "plan_name": "MHNET", "standard_charge_dollar": 1100.0, "methodology": "fee schedule" }, { "payer_name": "MHNET Medicare Advtg", "plan_name": "MHNET Medicare Advtg", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Commerical", "plan_name": "Molina Healthcare-Commerical", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 545.0, "methodology": "fee schedule" }, { "payer_name": "Montana Access Health", "plan_name": "Montana Access Health", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Mutual Of Omaha", "plan_name": "Mutual Of Omaha", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Nueces Center MHID", "plan_name": "Nueces Center MHID", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Optima Health", "plan_name": "Optima Health", "standard_charge_dollar": 1104.5, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Pan American Life", "plan_name": "Pan American Life", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Port Isabel", "plan_name": "Port Isabel", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Professional Benefit Administrators", "plan_name": "Professional Benefit Administrators", "standard_charge_dollar": 1150.0, "methodology": "fee schedule" }, { "payer_name": "Right Care From Scott & White - Medicaid", "plan_name": "Right Care From Scott & White - Medicaid", "standard_charge_dollar": 1550.0, "methodology": "fee schedule" }, { "payer_name": "Serving Children And Adults In Need, INC", "plan_name": "Serving Children And Adults In Need, INC", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", "standard_charge_dollar": 869.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare For Life", "plan_name": "Tricare For Life", "standard_charge_dollar": 720.0, "methodology": "fee schedule" }, { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 1009.85, "methodology": "fee schedule" }, { "payer_name": "TriWest WPS-VA", "plan_name": "TriWest WPS-VA", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Tropical Texas", "plan_name": "Tropical Texas", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "TTBH-UFUR", "plan_name": "TTBH-UFUR", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "UCT", "plan_name": "UCT", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "UHC United Shared Services", "plan_name": "UHC United Shared Services", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "United Health One", "plan_name": "United Health One", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 670.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 875.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 500.0, "maximum": 1550.0 } ] }, { "description": "Acute Gero CD R&B", "code_information": [ { "code": "126", "type": "RC" }, { "code": "41118", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 982.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1011.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Medicare", "plan_name": "Anthem BCBS Medicare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefits Administrators/IMS PPO", "plan_name": "Assured Benefits Administrators/IMS PPO", "standard_charge_dollar": 780.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 850.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Mcaid", "plan_name": "Beacon Mcaid", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "Boon Chapman", "plan_name": "Boon Chapman", "standard_charge_dollar": 953.0, "methodology": "fee schedule" }, { "payer_name": "Border Region", "plan_name": "Border Region", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Christus Health Plan- Commercial", "plan_name": "Christus Health Plan- Commercial", 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1550.0, "methodology": "fee schedule" }, { "payer_name": "Serving Children And Adults In Need, INC", "plan_name": "Serving Children And Adults In Need, INC", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 875.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", 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}, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 2350.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 2350.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 2350.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 2350.0, "methodology": "fee schedule" } ], "minimum": 2350.0, "maximum": 2350.0 } ] }, { "description": "ECT", "code_information": [ { "code": "90870", "type": "CPT" }, { "code": "47000", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 845.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", 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"standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 150.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 150.0, "maximum": 150.0 } ] }, { "description": "Adult Psych IOP 3 hrs", "code_information": [ { "code": "S9480", "type": "HCPCS" }, { "code": "43130", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 243.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Aetna Medicare", "standard_charge_dollar": 75.67, "methodology": "fee schedule" }, { "payer_name": "All Savers/UHC Network", "plan_name": "All Savers/UHC Network", 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1700.0, "discounted_cash": 175.0, "minimum": 75.67, "maximum": 794.39 } ] }, { "description": "Child/Adol Psych IOP 3 hrs", "code_information": [ { "code": "S9480", "type": "HCPCS" }, { "code": "43100", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 243.0, "methodology": "fee schedule" }, { "payer_name": "All Savers/UHC Network", "plan_name": "All Savers/UHC Network", "standard_charge_dollar": 275.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Medicare", "plan_name": "Anthem BCBS Medicare", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 275.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 190.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 220.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 247.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 235.0, "methodology": "fee schedule" }, { "payer_name": "Compass Connect", "plan_name": "Compass Connect", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", 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"Professional Benefit Administrators", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", "standard_charge_dollar": 258.0, "methodology": "fee schedule" }, { "payer_name": "United Health One", "plan_name": "United Health One", "standard_charge_dollar": 275.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Urban Strategies", "plan_name": "Urban Strategies", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Medicaid", "plan_name": "Wellpoint Medicaid", "standard_charge_dollar": 210.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 130.0, "maximum": 794.39 } ] }, { "description": "Gero Psych IOP 3 hrs", "code_information": [ { "code": "90853", "type": "CPT" }, { "code": "43140", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 243.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 190.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 220.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 247.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 235.0, "methodology": "fee schedule" }, { "payer_name": "Compass Connect", "plan_name": "Compass Connect", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 330.0, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "MHNET", "plan_name": "MHNET", "standard_charge_dollar": 220.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Optima Health", "plan_name": "Optima Health", "standard_charge_dollar": 658.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 275.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 275.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Medicaid", "plan_name": "Wellpoint Medicaid", "standard_charge_dollar": 210.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 130.0, "maximum": 658.0 } ] }, { "description": "IOP Child/Adol", "code_information": [ { "code": "S9480", "type": "HCPCS" }, { "code": "53010", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 130.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 175.0, "minimum": 130.0, "maximum": 130.0 } ] }, { "description": "Telehealth Adult Psych IOP 3 hrs", "code_information": [ { "code": "90853", "type": "CPT" }, { "code": "825", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Aetna Medicare", "standard_charge_dollar": 75.67, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 275.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 585.0, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 275.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "minimum": 75.67, "maximum": 585.0 } ] }, { "description": "Tri/Medi Adult IOP-1 unit", "code_information": [ { "code": "90853", "type": "CPT" }, { "code": "43131", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 192.53, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 192.53, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 192.53, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "minimum": 192.53, "maximum": 192.53 } ] }, { "description": "Tri/Medi Adult IOP-4 unit", "code_information": [ { "code": "90853", "type": "CPT" }, { "code": "43134", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 192.53, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "minimum": 192.53, "maximum": 192.53 } ] }, { "description": "Tri/Medi Child/Adol IOP-3 unit", "code_information": [ { "code": "90853", "type": "CPT" }, { "code": "43103", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 64.18, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "minimum": 64.18, "maximum": 64.18 } ] }, { "description": "Adol CD IOP 3 hrs", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "43150", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 247.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 235.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "minimum": 235.0, "maximum": 247.0 } ] }, { "description": "Adult CD IOP 3 hrs", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "43120", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 190.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 247.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 235.0, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 330.0, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 130.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 130.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "minimum": 130.0, "maximum": 330.0 } ] }, { "description": "Adult Psych PHP 6 hrs", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "42130", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 469.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Aetna Medicare", "standard_charge_dollar": 469.0, "methodology": "fee schedule" }, { "payer_name": "All Savers/UHC Network", "plan_name": "All Savers/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Medicare", "plan_name": "Anthem BCBS Medicare", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefits Administrators/IMS PPO", "plan_name": "Assured Benefits Administrators/IMS PPO", "standard_charge_dollar": 270.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 375.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 205.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "BCFS/PCU", "plan_name": "BCFS/PCU", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 395.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Mcaid", "plan_name": "Beacon Mcaid", "standard_charge_dollar": 205.0, "methodology": "fee schedule" }, { "payer_name": "Border Region", "plan_name": "Border Region", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 394.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 375.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcaid", "plan_name": "Cigna Healthspring- Mcaid", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Coastal Plains", "plan_name": "Coastal Plains", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Community First - Mcaid", "plan_name": "Community First - Mcaid", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Compass Connect", "plan_name": "Compass Connect", "standard_charge_dollar": 450.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 450.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits/IMS PPO", "plan_name": "Continental Benefits/IMS PPO", "standard_charge_dollar": 270.0, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 794.39, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan STAR Kids", "plan_name": "Driscoll Health Plan STAR Kids", "standard_charge_dollar": 786.44, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Friday Health Plans", "plan_name": "Friday Health Plans", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "GEHA/UHC Network", "plan_name": "GEHA/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 205.0, "methodology": "fee schedule" }, { "payer_name": "IES/PCU", "plan_name": "IES/PCU", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360", "plan_name": "Imagine 360", "standard_charge_dollar": 376.0, "methodology": "fee schedule" }, { "payer_name": "MHNET", "plan_name": "MHNET", "standard_charge_dollar": 420.0, "methodology": "fee schedule" }, { "payer_name": "MHNET Medicare Advtg", "plan_name": "MHNET Medicare Advtg", "standard_charge_dollar": 205.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Commerical", "plan_name": "Molina Healthcare-Commerical", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 205.0, "methodology": "fee schedule" }, { "payer_name": "Mutual Of Omaha", "plan_name": "Mutual Of Omaha", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Optima Health", "plan_name": "Optima Health", "standard_charge_dollar": 963.5, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Pan American Life", "plan_name": "Pan American Life", "standard_charge_dollar": 750.0, "methodology": "fee schedule" }, { "payer_name": "Port Isabel", "plan_name": "Port Isabel", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Professional Benefit Administrators", "plan_name": "Professional Benefit Administrators", "standard_charge_dollar": 450.0, "methodology": "fee schedule" }, { "payer_name": "Right Care From Scott & White - Medicaid", "plan_name": "Right Care From Scott & White - Medicaid", "standard_charge_dollar": 550.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", "standard_charge_dollar": 375.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 205.0, "methodology": "fee schedule" }, { "payer_name": "UCT", "plan_name": "UCT", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "UHC United Shared Services", "plan_name": "UHC United Shared Services", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "United Health One", "plan_name": "United Health One", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 225.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Mcare Advtg", "plan_name": "Wellcare Mcare Advtg", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Medicaid", "plan_name": "Wellpoint Medicaid", "standard_charge_dollar": 360.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 350.0, "minimum": 175.0, "maximum": 963.5 } ] }, { "description": "Child/Adol Phych PHP 6 hrs", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "42100", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "90 Degree Benefits", "plan_name": "90 Degree Benefits", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 469.0, "methodology": "fee schedule" }, { "payer_name": "All Savers/UHC Network", "plan_name": "All Savers/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Medicare", "plan_name": "Anthem BCBS Medicare", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefits Administrators/IMS PPO", "plan_name": "Assured Benefits Administrators/IMS PPO", "standard_charge_dollar": 270.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO TX", "plan_name": "BCBS HMO TX", "standard_charge_dollar": 375.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 395.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 394.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 375.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcaid", "plan_name": "Cigna Healthspring- Mcaid", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Community First - Mcaid", "plan_name": "Community First - Mcaid", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Compass Connect", "plan_name": "Compass Connect", "standard_charge_dollar": 450.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 450.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits/IMS PPO", "plan_name": "Continental Benefits/IMS PPO", "standard_charge_dollar": 270.0, "methodology": "fee schedule" }, { "payer_name": "CURATIVE- FIRST HEALTH", "plan_name": "CURATIVE- FIRST HEALTH", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 794.39, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan STAR Kids", "plan_name": "Driscoll Health Plan STAR Kids", "standard_charge_dollar": 786.44, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Friday Health Plans", "plan_name": "Friday Health Plans", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "GEHA/UHC Network", "plan_name": "GEHA/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360", "plan_name": "Imagine 360", "standard_charge_dollar": 376.0, "methodology": "fee schedule" }, { "payer_name": "MHNET", "plan_name": "MHNET", "standard_charge_dollar": 420.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "Optima Health", "plan_name": "Optima Health", "standard_charge_dollar": 963.5, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Professional Benefit Administrators", "plan_name": "Professional Benefit Administrators", "standard_charge_dollar": 450.0, "methodology": "fee schedule" }, { "payer_name": "Right Care From Scott & White - Medicaid", "plan_name": "Right Care From Scott & White - Medicaid", "standard_charge_dollar": 550.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan", "standard_charge_dollar": 376.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 498.75, "methodology": "fee schedule" }, { "payer_name": "UHC United Shared Services", "plan_name": "UHC United Shared Services", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "United Health One", "plan_name": "United Health One", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "UPBRING", "plan_name": "UPBRING", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Urban Strategies", "plan_name": "Urban Strategies", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Wellpoint Medicaid", "plan_name": "Wellpoint Medicaid", "standard_charge_dollar": 360.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 350.0, "minimum": 175.0, "maximum": 963.5 } ] }, { "description": "Gero Psych PHP 6 hrs", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "42140", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Beacon Health Options", "plan_name": "Beacon Health Options", "standard_charge_dollar": 395.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 394.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 375.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 425.0, "methodology": "fee schedule" }, { "payer_name": "Wellcare Mcare Advtg", "plan_name": "Wellcare Mcare Advtg", "standard_charge_dollar": 325.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 350.0, "minimum": 325.0, "maximum": 425.0 } ] }, { "description": "Telehealth PHP Psych Adult Daily", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "846", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 350.0, "minimum": 200.0, "maximum": 425.0 } ] }, { "description": "Tri/Medi Adult IOP-2 unit", "code_information": [ { "code": "90853", "type": "CPT" }, { "code": "43132", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 192.53, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 96.27, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 96.27, "methodology": "fee schedule" } ], "gross_charge": 850.0, "minimum": 96.27, "maximum": 192.53 } ] }, { "description": "Tri/Medi Adult IOP-3 unit", "code_information": [ { "code": "90853", "type": "CPT" }, { "code": "43133", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Aetna Medicare", "standard_charge_dollar": 75.67, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 192.53, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 64.18, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 64.18, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 58.33, "methodology": "fee schedule" } ], "gross_charge": 566.67, "minimum": 58.33, "maximum": 192.53 } ] }, { "description": "Tri/Medi Adult PHP - 1 unit", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "2031", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 498.75, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 65.0, "minimum": 498.75, "maximum": 498.75 } ] }, { "description": "Tri/Medi Adult PHP - 2 unit", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "2032", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 249.37, "methodology": "fee schedule" } ], "gross_charge": 1250.0, "discounted_cash": 65.0, "minimum": 249.37, "maximum": 249.37 } ] }, { "description": "Tri/Medi Adult PHP - 3 unit", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "2033", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 166.25, "methodology": "fee schedule" } ], "gross_charge": 833.33, "discounted_cash": 65.0, "minimum": 166.25, "maximum": 166.25 } ] }, { "description": "Tri/Medi Adult PHP - 4 unit", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "2034", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 124.68, "methodology": "fee schedule" } ], "gross_charge": 625.0, "discounted_cash": 65.0, "minimum": 124.68, "maximum": 124.68 } ] }, { "description": "Tri/Medi Adult PHP-1 unit", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "42131", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 192.53, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 192.53, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 65.0, "minimum": 192.53, "maximum": 198.0 } ] }, { "description": "Tri/Medi Adult PHP-2 units", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "42132", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 96.27, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 96.27, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 65.0, "minimum": 96.27, "maximum": 198.0 } ] }, { "description": "Tri/Medi Adult PHP-3 units", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "42133", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 64.18, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 64.18, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 65.0, "minimum": 64.18, "maximum": 198.0 } ] }, { "description": "Tri/Medi Adult PHP-4 units", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "42134", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Aetna Medicare", "standard_charge_dollar": 113.75, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 60.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 48.13, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 48.13, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 65.0, "minimum": 48.13, "maximum": 198.0 } ] }, { "description": "Tri/Medi Adult PHP-5 units", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "42135", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 469.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefits Administrators/IMS PPO", "plan_name": "Assured Benefits Administrators/IMS PPO", "standard_charge_dollar": 54.0, "methodology": "fee schedule" }, { "payer_name": "BCBS HMO MAGELLAN", "plan_name": "BCBS HMO MAGELLAN", "standard_charge_dollar": 275.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Medicare Advantage", "plan_name": "BCBS Medicare Advantage", "standard_charge_dollar": 41.0, "methodology": "fee schedule" }, { "payer_name": "BCBS PPO TX", "plan_name": "BCBS PPO TX", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "BCFS/PCU", "plan_name": "BCFS/PCU", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Beacon Mcaid", "plan_name": "Beacon Mcaid", "standard_charge_dollar": 41.0, "methodology": "fee schedule" }, { "payer_name": "Border Region", "plan_name": "Border Region", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Cigna -Commercial", "plan_name": "Cigna -Commercial", "standard_charge_dollar": 394.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Blue Star", "plan_name": "Cigna Blue Star", "standard_charge_dollar": 375.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcaid", "plan_name": "Cigna Healthspring- Mcaid", "standard_charge_dollar": 50.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Healthspring- Mcare", "plan_name": "Cigna Healthspring- Mcare", "standard_charge_dollar": 41.0, "methodology": "fee schedule" }, { "payer_name": "Coastal Plains", "plan_name": "Coastal Plains", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Community First - Mcaid", "plan_name": "Community First - Mcaid", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "ComPsych", "plan_name": "ComPsych", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits/IMS PPO", "plan_name": "Continental Benefits/IMS PPO", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Driscoll Health Plan Mcaid", "plan_name": "Driscoll Health Plan Mcaid", "standard_charge_dollar": 41.0, "methodology": "fee schedule" }, { "payer_name": "Fidelis Care Medicaid", "plan_name": "Fidelis Care Medicaid", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "GEHA/UHC Network", "plan_name": "GEHA/UHC Network", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 41.0, "methodology": "fee schedule" }, { "payer_name": "IES/PCU", "plan_name": "IES/PCU", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Imagine 360", "plan_name": "Imagine 360", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "MHNET", "plan_name": "MHNET", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "MHNET Medicare Advtg", "plan_name": "MHNET Medicare Advtg", "standard_charge_dollar": 41.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Commerical", "plan_name": "Molina Healthcare-Commerical", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcaid", "plan_name": "Molina Healthcare-Mcaid", "standard_charge_dollar": 41.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare-Mcare", "plan_name": "Molina Healthcare-Mcare", "standard_charge_dollar": 38.51, "methodology": "fee schedule" }, { "payer_name": "Mutual Of Omaha", "plan_name": "Mutual Of Omaha", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Optima Health", "plan_name": "Optima Health", "standard_charge_dollar": 963.5, "methodology": "fee schedule" }, { "payer_name": "Pan American Life", "plan_name": "Pan American Life", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "Port Isabel", "plan_name": "Port Isabel", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Professional Benefit Administrators", "plan_name": "Professional Benefit Administrators", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Southwest Keys/PCU", "plan_name": "Southwest Keys/PCU", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Sunrest/UHG", "plan_name": "Sunrest/UHG", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "Superior Ambetter", "plan_name": "Superior Ambetter", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcaid", "plan_name": "Superior/Cenpatico Mcaid", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Superior/Cenpatico Mcare", "plan_name": "Superior/Cenpatico Mcare", "standard_charge_dollar": 198.0, "methodology": "fee schedule" }, { "payer_name": "TML/UHC Network", "plan_name": "TML/UHC Network", "standard_charge_dollar": 275.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 38.51, "methodology": "fee schedule" }, { "payer_name": "UCT", "plan_name": "UCT", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "UHC United Shared Services", "plan_name": "UHC United Shared Services", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "UMR/UHC Network", "plan_name": "UMR/UHC Network", "standard_charge_dollar": 70.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcaid", "plan_name": "United Healthcare Mcaid", "standard_charge_dollar": 41.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Mcare", "plan_name": "United Healthcare Mcare", "standard_charge_dollar": 41.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare-Commercial", "plan_name": "United Healthcare-Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule" } ], "gross_charge": 500.0, "discounted_cash": 65.0, "minimum": 38.51, "maximum": 963.5 } ] }, { "description": "Tri/Medi Child/Adol PHP - 1 un", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "2001", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 498.75, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 65.0, "minimum": 498.75, "maximum": 498.75 } ] }, { "description": "Tri/Medi Child/Adol PHP - 2 un", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "2002", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 249.37, "methodology": "fee schedule" } ], "gross_charge": 1250.0, "discounted_cash": 65.0, "minimum": 249.37, "maximum": 249.37 } ] }, { "description": "Tri/Medi Child/Adol PHP - 3 un", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "2003", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 166.25, "methodology": "fee schedule" } ], "gross_charge": 833.33, "discounted_cash": 65.0, "minimum": 166.25, "maximum": 166.25 } ] }, { "description": "Tri/Medi Child/Adol PHP - 4 un", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "2004", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare West", "plan_name": "Tricare West", "standard_charge_dollar": 124.68, "methodology": "fee schedule" } ], "gross_charge": 625.0, "discounted_cash": 65.0, "minimum": 124.68, "maximum": 124.68 } ] }, { "description": "Tri/Medi Child/Adol PHP-1 unit", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "42110", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 192.53, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 65.0, "minimum": 192.53, "maximum": 192.53 } ] }, { "description": "Tri/Medi Child/Adol PHP-5 unit", "code_information": [ { "code": "G0411", "type": "HCPCS" }, { "code": "42115", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 41.0, "methodology": "fee schedule" } ], "gross_charge": 500.0, "discounted_cash": 65.0, "minimum": 41.0, "maximum": 41.0 } ] } ] }