{ "hospital_name": "SBH-El Paso, LLC", "last_updated_on": "2026-05-20", "version": "3.0.0", "location_name": [ "Peak Behavioral Health" ], "hospital_address": [ "5045, 5055, and 5065 McNutt Road, Santa Teresa, NM 88008" ], "license_information": { "state": "NM", "license_number": "141" }, "type_2_npi": [ "1053652438" ], "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": "Amy Alexander" }, "standard_charge_information": [ { "description": "Bridge Services", "code_information": [ { "code": "H0032", "type": "HCPCS" }, { "code": "5130", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "BCBS CENTENNIAL", "plan_name": "BCBS CENTENNIAL", "standard_charge_dollar": 80.0, "methodology": "fee schedule" }, { "payer_name": "MOLINA CENTENNIAL", "plan_name": "MOLINA CENTENNIAL", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "PRESBYTERIAN CENTENNIAL", "plan_name": "PRESBYTERIAN CENTENNIAL", "standard_charge_dollar": 86.7, "methodology": "fee schedule" }, { "payer_name": "PRESBYTERIAN HEALTH PLAN", "plan_name": "PRESBYTERIAN HEALTH PLAN", "standard_charge_dollar": 80.0, "methodology": "fee schedule" }, { "payer_name": "SUPERIOR HEALTHPLAN", "plan_name": "SUPERIOR HEALTHPLAN", "standard_charge_dollar": 20.0, "methodology": "fee schedule" }, { "payer_name": "Western Sky Centene - Centennial", "plan_name": "Western Sky Centene - Centennial", "standard_charge_dollar": 75.0, "methodology": "fee schedule" } ], "minimum": 20.0, "maximum": 150.0 } ] }, { "description": "RTC Psych R&B", "code_information": [ { "code": "1001", "type": "RC" }, { "code": "5007", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 706.0, "methodology": "fee schedule" }, { "payer_name": "AETNA MEDICARE MANAGED", "plan_name": "AETNA MEDICARE MANAGED", "standard_charge_dollar": 2400.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter Superior Health Plan", "plan_name": "Ambetter Superior Health Plan", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "AMERIGROUP OF TX MEDICARE", "plan_name": "AMERIGROUP OF TX MEDICARE", "standard_charge_dollar": 2400.0, "methodology": "fee schedule" }, { "payer_name": "AMERIGRP TX MEDICAID", "plan_name": "AMERIGRP TX MEDICAID", "standard_charge_dollar": 2400.0, "methodology": "fee schedule" }, { "payer_name": "BCBS CENTENNIAL", "plan_name": "BCBS CENTENNIAL", "standard_charge_dollar": 455.0, "methodology": "fee schedule" }, { "payer_name": "BLUE CROSS FEDERAL", "plan_name": "BLUE CROSS FEDERAL", "standard_charge_dollar": 680.0, "methodology": "fee schedule" }, { "payer_name": "BLUE CROSS NEW MEXICO", "plan_name": "BLUE CROSS NEW MEXICO", "standard_charge_dollar": 680.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Behavioral Health", "plan_name": "Cigna Behavioral Health", "standard_charge_dollar": 512.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Behavioral Health/Optum", "plan_name": "Cigna Behavioral Health/Optum", "standard_charge_dollar": 512.0, "methodology": "fee schedule" }, { "payer_name": "CYFD ATTN Jeff Tinstman", "plan_name": "CYFD ATTN Jeff Tinstman", "standard_charge_dollar": 288.83, "methodology": "fee schedule" }, { "payer_name": "EBC", "plan_name": "EBC", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "EL PASO HEALTH", "plan_name": "EL PASO HEALTH", "standard_charge_dollar": 385.0, "methodology": "fee schedule" }, { "payer_name": "El Paso Health Chip", "plan_name": "El Paso Health Chip", "standard_charge_dollar": 385.0, "methodology": "fee schedule" }, { "payer_name": "FFS OPTUM HEALTH NM ACUTE", "plan_name": "FFS OPTUM HEALTH NM ACUTE", "standard_charge_dollar": 270.0, "methodology": "fee schedule" }, { "payer_name": "GEHA", "plan_name": "GEHA", "standard_charge_dollar": 450.0, "methodology": "fee schedule" }, { "payer_name": "MERITAIN HEALTH", "plan_name": "MERITAIN HEALTH", "standard_charge_dollar": 433.0, "methodology": "fee schedule" }, { "payer_name": "MESA MENTAL HEALTH", "plan_name": "MESA MENTAL HEALTH", "standard_charge_dollar": 375.0, "methodology": "fee schedule" }, { "payer_name": "MHN", "plan_name": "MHN", "standard_charge_dollar": 866.0, "methodology": "fee schedule" }, { "payer_name": "MOLINA CENTENNIAL", "plan_name": "MOLINA CENTENNIAL", "standard_charge_dollar": 754.74, "methodology": "fee schedule" }, { "payer_name": "NM HEALTH CONNECTIONS", "plan_name": "NM HEALTH CONNECTIONS", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM HEALTH", "plan_name": "OPTUM HEALTH", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM HEALTH NM", "plan_name": "OPTUM HEALTH NM", "standard_charge_dollar": 353.0, "methodology": "fee schedule" }, { "payer_name": "Point Comfort Underwriters", "plan_name": "Point Comfort Underwriters", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "PREFERRED ADMINISTRATORS", "plan_name": "PREFERRED ADMINISTRATORS", "standard_charge_dollar": 385.0, "methodology": "fee schedule" }, { "payer_name": "PRESBYTERIAN CENTENNIAL", "plan_name": "PRESBYTERIAN CENTENNIAL", "standard_charge_dollar": 372.3, "methodology": "fee schedule" }, { "payer_name": "PRESBYTERIAN HEALTH PLAN", "plan_name": "PRESBYTERIAN HEALTH PLAN", "standard_charge_dollar": 475.0, "methodology": "fee schedule" }, { "payer_name": "SUPERIOR HEALTHPLAN", "plan_name": "SUPERIOR HEALTHPLAN", "standard_charge_dollar": 955.0, "methodology": "fee schedule" }, { "payer_name": "TRICARE FOR LIFE", "plan_name": "TRICARE FOR LIFE", "standard_charge_dollar": 213.44, "methodology": "fee schedule" }, { "payer_name": "Triwest Tricare", "plan_name": "Triwest Tricare", "standard_charge_dollar": 1406.0, "methodology": "fee schedule" }, { "payer_name": "UHC CENTENNIAL", "plan_name": "UHC CENTENNIAL", "standard_charge_dollar": 560.16, "methodology": "fee schedule" }, { "payer_name": "UHC Community Plan Of WASHINGTON", "plan_name": "UHC Community Plan Of WASHINGTON", "standard_charge_dollar": 350.0, "methodology": "fee schedule" }, { "payer_name": "UHC/SUREST", "plan_name": "UHC/SUREST", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "UMR/HEALTHSCOPE", "plan_name": "UMR/HEALTHSCOPE", "standard_charge_dollar": 348.0, "methodology": "fee schedule" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "UNITED BEHAVIORAL SHARED SERVICES", "plan_name": "UNITED BEHAVIORAL SHARED SERVICES", "standard_charge_dollar": 800.0, "methodology": "fee schedule" }, { "payer_name": "UNITEDHEALTH MILITARY", "plan_name": "UNITEDHEALTH MILITARY", "standard_charge_dollar": 866.0, "methodology": "fee schedule" }, { "payer_name": "VALUE OPTIONS COMM", "plan_name": "VALUE OPTIONS COMM", "standard_charge_dollar": 379.0, "methodology": "fee schedule" }, { "payer_name": "WELLPOINT", "plan_name": "WELLPOINT", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "Western Sky Centene - Centennial", "plan_name": "Western Sky Centene - Centennial", "standard_charge_dollar": 459.0, "methodology": "fee schedule" }, { "payer_name": "YSLETA DEL SUR PUEBLO", "plan_name": "YSLETA DEL SUR PUEBLO", "standard_charge_dollar": 450.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 350.0, "minimum": 213.44, "maximum": 2400.0 } ] }, { "description": "Acute Adol R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "5003", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "ACCESS ADMIN - ADVANTAGE", "plan_name": "ACCESS ADMIN - ADVANTAGE", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "ACI", "plan_name": "ACI", "standard_charge_dollar": 900.0, "methodology": "fee schedule" }, { "payer_name": "ADMINONE", "plan_name": "ADMINONE", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1107.0, "methodology": "fee schedule" }, { "payer_name": "AETNA MEDICARE MANAGED", "plan_name": "AETNA MEDICARE MANAGED", "standard_charge_dollar": 888.0, "methodology": "fee schedule" }, { "payer_name": "AHCCCS MEDICAID", "plan_name": "AHCCCS MEDICAID", "standard_charge_dollar": 816.39, "methodology": "fee schedule" }, { "payer_name": "ALBUQUERQUE INDIAN HEALTH CENTER", "plan_name": "ALBUQUERQUE INDIAN HEALTH CENTER", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "ALL SAVERS", "plan_name": "ALL SAVERS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "ALLIUM GLOBAL ASSISTANT", "plan_name": "ALLIUM GLOBAL ASSISTANT", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter Superior Health Plan", "plan_name": "Ambetter Superior Health Plan", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "AMERIGROUP OF LOUISIANA", "plan_name": "AMERIGROUP OF LOUISIANA", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "AMERIGROUP OF NM Man MCR", "plan_name": "AMERIGROUP OF NM Man MCR", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "AMERIGROUP OF TX MEDICARE", "plan_name": "AMERIGROUP OF TX MEDICARE", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "AMERIGRP TX MEDICAID", "plan_name": "AMERIGRP TX MEDICAID", "standard_charge_dollar": 529.29, "methodology": "fee schedule" }, { "payer_name": "APACHE WHITERIVER IHS", "plan_name": "APACHE WHITERIVER IHS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "ASSURANT HEALTH", "plan_name": "ASSURANT HEALTH", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "ASSURED BENEFITS", "plan_name": "ASSURED BENEFITS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "ASSURED BENEFITS ADMINISTRATORS", "plan_name": "ASSURED BENEFITS ADMINISTRATORS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "AZ COMPLETE HEALTHCARE PLAN", "plan_name": "AZ COMPLETE HEALTHCARE PLAN", "standard_charge_dollar": 816.39, "methodology": "fee schedule" }, { "payer_name": "BANNER UNIVERSITY FAMILY CARE", "plan_name": "BANNER UNIVERSITY FAMILY CARE", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "BAS HEALTH PLANS", "plan_name": "BAS HEALTH PLANS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "BCBS CENTENNIAL", "plan_name": "BCBS CENTENNIAL", "standard_charge_dollar": 811.33, "methodology": "fee schedule" }, { "payer_name": "BCBS MEDI CAL PROMISE HEALTH PLAN", "plan_name": "BCBS MEDI CAL PROMISE HEALTH PLAN", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "BCBS MEDICARE ADVANTAGE HMO", "plan_name": "BCBS MEDICARE ADVANTAGE HMO", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "BCBS NEVADA MEDICAID", "plan_name": "BCBS NEVADA MEDICAID", "standard_charge_dollar": 595.0, "methodology": "fee schedule" }, { "payer_name": "BCBS OF CALIFORNIA", "plan_name": "BCBS OF CALIFORNIA", "standard_charge_dollar": 742.0, "methodology": "fee schedule" }, { "payer_name": "BCBS TX", "plan_name": "BCBS TX", "standard_charge_dollar": 990.0, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 975.0, "methodology": "fee schedule" }, { "payer_name": "BLUE CROSS FEDERAL", "plan_name": "BLUE CROSS FEDERAL", "standard_charge_dollar": 990.0, "methodology": "fee schedule" }, { "payer_name": "BLUE CROSS NEW MEXICO", "plan_name": "BLUE CROSS NEW MEXICO", "standard_charge_dollar": 990.0, "methodology": "fee schedule" }, { "payer_name": "BOONCHAPMAN", "plan_name": "BOONCHAPMAN", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "BRAVO HEALTH", "plan_name": "BRAVO HEALTH", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "CAL-OPTIMA/MEDI-CAL", "plan_name": "CAL-OPTIMA/MEDI-CAL", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "CAN-Assistant", "plan_name": "CAN-Assistant", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Capital Blue Cross", "plan_name": "Capital Blue Cross", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "CAPROCK HEALTHPLANS", "plan_name": "CAPROCK HEALTHPLANS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "CARE 1ST HEALTH PLAN", "plan_name": "CARE 1ST HEALTH PLAN", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "CARELON BEHAVIORAL", "plan_name": "CARELON BEHAVIORAL", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Century Healthcare", "plan_name": "Century Healthcare", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Behavioral Health", "plan_name": "Cigna Behavioral Health", "standard_charge_dollar": 768.0, "methodology": "fee schedule" }, { "payer_name": "Cigna Behavioral Health/Optum", "plan_name": "Cigna Behavioral Health/Optum", "standard_charge_dollar": 768.0, "methodology": "fee schedule" }, { "payer_name": "CIGNA HEALTHSPRING M/C Replacement", "plan_name": "CIGNA HEALTHSPRING M/C Replacement", "standard_charge_dollar": 595.0, "methodology": "fee schedule" }, { "payer_name": "Community First Health Plan Star Medicai", "plan_name": "Community First Health Plan Star Medicai", "standard_charge_dollar": 529.59, "methodology": "fee schedule" }, { "payer_name": "COMPSYCH", "plan_name": "COMPSYCH", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Continental Benefits", "plan_name": "Continental Benefits", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "COOK CHILDREN'S HEALTH PLAN", "plan_name": "COOK CHILDREN'S HEALTH PLAN", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Coordinated Care Of Washington", "plan_name": "Coordinated Care Of Washington", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "CORE SOURCE", "plan_name": "CORE SOURCE", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "COVENTRY", "plan_name": "COVENTRY", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Devoted Health Plan Of Texas", "plan_name": "Devoted Health Plan Of Texas", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "DFPS", "plan_name": "DFPS", "standard_charge_dollar": 650.0, "methodology": "fee schedule" }, { "payer_name": "EBC", "plan_name": "EBC", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "EBSO", "plan_name": "EBSO", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "El Paso Children's Hospital", "plan_name": "El Paso Children's Hospital", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "EL PASO HEALTH", "plan_name": "EL PASO HEALTH", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "El Paso Health Chip", "plan_name": "El Paso Health Chip", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "EMERGENCE HEALTH NETWORK - GPA", "plan_name": "EMERGENCE HEALTH NETWORK - GPA", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "FFS OPTUM HEALTH NM ACUTE", "plan_name": "FFS OPTUM HEALTH NM ACUTE", "standard_charge_dollar": 485.0, "methodology": "fee schedule" }, { "payer_name": "FIRST HEALTH INDEMNITY", "plan_name": "FIRST HEALTH INDEMNITY", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "FIRSTCARE STAR", "plan_name": "FIRSTCARE STAR", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "FORT DEFIANCE INDIAN HOSPITAL", "plan_name": "FORT DEFIANCE INDIAN HOSPITAL", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "GALLUP Indian Health Services", "plan_name": "GALLUP Indian Health Services", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "GEHA", "plan_name": "GEHA", "standard_charge_dollar": 623.0, "methodology": "fee schedule" }, { "payer_name": "GPA", "plan_name": "GPA", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "GROUP PENSION ADMIN", "plan_name": "GROUP PENSION ADMIN", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "GROUP RESOURCES", "plan_name": "GROUP RESOURCES", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "HCC MEDICAL INSURANCE SERVICES", "plan_name": "HCC MEDICAL INSURANCE SERVICES", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "HEALTH COST SOLUTION", "plan_name": "HEALTH COST SOLUTION", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "HEALTH PLAN OF NEVADA MEDICAID", "plan_name": "HEALTH PLAN OF NEVADA MEDICAID", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "HEALTHNET", "plan_name": "HEALTHNET", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope", "plan_name": "Healthscope", "standard_charge_dollar": 595.0, "methodology": "fee schedule" }, { "payer_name": "HEALTHSMART BENEFIT SOLUT PPO PLUS", "plan_name": "HEALTHSMART BENEFIT SOLUT PPO PLUS", "standard_charge_dollar": 550.0, "methodology": "fee schedule" }, { "payer_name": "HMA EMPLOYEE BENEFITS", "plan_name": "HMA EMPLOYEE BENEFITS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "HMC Healthworks", "plan_name": "HMC Healthworks", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "HUMANA COMMERCIAL PLAN", "plan_name": "HUMANA COMMERCIAL PLAN", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "HUMANA GO CHOICE", "plan_name": "HUMANA GO CHOICE", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Humana Tricare East", "plan_name": "Humana Tricare East", "standard_charge_dollar": 762.0, "methodology": "fee schedule" }, { "payer_name": "ICE HEALTH SERVICES CORPS", "plan_name": "ICE HEALTH SERVICES CORPS", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "INSURANCE MANANGEMENT SERVICES", "plan_name": "INSURANCE MANANGEMENT SERVICES", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "INSURANCE SERVICES OF LUBBOCK", "plan_name": "INSURANCE SERVICES OF LUBBOCK", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "INTERCOMMUNITY HEALTH PLANS", "plan_name": "INTERCOMMUNITY HEALTH PLANS", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "KAISER PERMANENTE", "plan_name": "KAISER PERMANENTE", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "LOVELACE MEDICARE PLAN", "plan_name": "LOVELACE MEDICARE PLAN", "standard_charge_dollar": 602.0, "methodology": "fee schedule" }, { "payer_name": "LOVELACE SALUD", "plan_name": "LOVELACE SALUD", "standard_charge_dollar": 475.0, "methodology": "fee schedule" }, { "payer_name": "MAGELLAN BEHAVIORAL", "plan_name": "MAGELLAN BEHAVIORAL", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Mail Handlers Benefits", "plan_name": "Mail Handlers Benefits", "standard_charge_dollar": 540.0, "methodology": "fee schedule" }, { "payer_name": "MAINE MEDICAID SERVICES", "plan_name": "MAINE MEDICAID SERVICES", "standard_charge_dollar": 700.0, "methodology": "fee schedule" }, { "payer_name": "MARICOPA CARE ADVANTAGE", "plan_name": "MARICOPA CARE ADVANTAGE", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "MASS GENERAL BRIGHAM HEALTH PLAN", "plan_name": "MASS GENERAL BRIGHAM HEALTH PLAN", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "MEDI-CAL", "plan_name": "MEDI-CAL", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, 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"standard_charge_dollar": 512.0, "methodology": "fee schedule" }, { "payer_name": "CYFD ATTN Jeff Tinstman", "plan_name": "CYFD ATTN Jeff Tinstman", "standard_charge_dollar": 288.83, "methodology": "fee schedule" }, { "payer_name": "EBC", "plan_name": "EBC", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "EL PASO HEALTH", "plan_name": "EL PASO HEALTH", "standard_charge_dollar": 385.0, "methodology": "fee schedule" }, { "payer_name": "El Paso Health Chip", "plan_name": "El Paso Health Chip", "standard_charge_dollar": 385.0, "methodology": "fee schedule" }, { "payer_name": "FFS OPTUM HEALTH NM ACUTE", "plan_name": "FFS OPTUM HEALTH NM ACUTE", "standard_charge_dollar": 270.0, "methodology": "fee schedule" }, { "payer_name": "GEHA", "plan_name": "GEHA", "standard_charge_dollar": 450.0, "methodology": "fee schedule" }, { "payer_name": "MERITAIN HEALTH", "plan_name": "MERITAIN HEALTH", "standard_charge_dollar": 433.0, "methodology": "fee schedule" }, { 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"standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "MOLINA HEALTHCARE OF TX MEDICARE", "plan_name": "MOLINA HEALTHCARE OF TX MEDICARE", "standard_charge_dollar": 0.65, "methodology": "fee schedule" }, { "payer_name": "TEXAS MEDICAID HEALTHCARE", "plan_name": "TEXAS MEDICAID HEALTHCARE", "standard_charge_dollar": 0.65, "methodology": "fee schedule" }, { "payer_name": "UBH TX MEDICAID", "plan_name": "UBH TX MEDICAID", "standard_charge_dollar": 0.65, "methodology": "fee schedule" } ], "gross_charge": 250.0, "minimum": 0.65, "maximum": 0.65 } ] }, { "description": "Subsequent Hosp visit 15 min", "code_information": [ { "code": "99231", "type": "CPT" }, { "code": "299231", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "MOLINA HEALTHCARE OF TX MEDICARE", "plan_name": "MOLINA HEALTHCARE OF TX MEDICARE", "standard_charge_dollar": 0.65, "methodology": "fee schedule" }, { "payer_name": "TEXAS MEDICAID HEALTHCARE", "plan_name": "TEXAS MEDICAID HEALTHCARE", "standard_charge_dollar": 0.65, "methodology": "fee schedule" }, { "payer_name": "UBH TX MEDICAID", "plan_name": "UBH TX MEDICAID", "standard_charge_dollar": 0.65, "methodology": "fee schedule" } ], "gross_charge": 140.0, "minimum": 0.65, "maximum": 0.65 } ] } ] }