{
  "hospital_name": "Corpus Christi Rehabilitation Hospital",
  "last_updated_on": "2026-01-01",
  "version": "2.0.0",
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    "5726 Esplanade Dr, Corpus Christi, TX 78414"
  ],
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    "state": "TX"
  },
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    "affirmation": "To the best of its knowledge and belief, the 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 indicated.",
    "confirm_affirmation": true
  },
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            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
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              "payer_name": "Aetna Network Services",
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            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
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              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
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              "methodology": "fee schedule"
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              "payer_name": "Aetna Network Services",
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              "payer_name": "Aetna Network Services",
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              "payer_name": "Aetna Network Services",
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              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 28,
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            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Group Health and Wellness Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Health Maintenance Organization Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Self-funded Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 27.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
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              "estimated_amount": 27.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 28,
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            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
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              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 33.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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            },
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              "payer_name": "Molina Healthcare of Texas",
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              "payer_name": "Molina Healthcare of Texas",
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            },
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              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "payer_name": "Molina Healthcare of Texas",
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              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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            },
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              "payer_name": "Medicaid (State)",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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          ],
          "minimum": 21.31,
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      ]
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    {
      "description": "Therapeutic activities",
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        {
          "code": "97530",
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        }
      ],
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            },
            {
              "payer_name": "AlterNet Medical Services",
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            },
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              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 33.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 34.6,
              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 34.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26.85,
          "maximum": 65
        }
      ]
    },
    {
      "description": "Neuromuscular reeducation",
      "code_information": [
        {
          "code": "97112",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "AlterNet Medical Services",
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              "payer_name": "WellPoint fka AmeriGroup Texas",
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          ],
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    },
    {
      "description": "Gait training therapy",
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        {
          "code": "97116",
          "type": "HCPCS"
        }
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              "payer_name": "Molina Healthcare of Texas",
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            },
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              "payer_name": "Molina Healthcare of Texas",
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              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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            },
            {
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              "estimated_amount": 28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
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      "description": "Speech/hearing therapy",
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              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "payer_name": "Texas Independence Health Plan (TIHP)",
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            },
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            },
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          ],
          "minimum": 51.73,
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      ]
    },
    {
      "description": "Manual therapy 1/> regions",
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        {
          "code": "97140",
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              "payer_name": "WellPoint fka AmeriGroup Texas",
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          ],
          "minimum": 19.6,
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    },
    {
      "description": "Pt eval mod complex 30 min",
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        {
          "code": "97162",
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        }
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              "plan_name": "Elect Choice",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Open Choice",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Managed Choice POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Choice POS II",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "indemnity plans with network incentives",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Signature Administrators®",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Joint Claims Administration",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Passport to Healthcare",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "National Advantage Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Group Health and Wellness Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Health Maintenance Organization Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Self-funded Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Insurance Company Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 93.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 93.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "CHIP",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "STAR Kids",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP MCO",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP Perinatal",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP RSA",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 90.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 90.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 72.51,
          "maximum": 260
        }
      ]
    },
    {
      "description": "Ther ivntj ea addl 15 min",
      "code_information": [
        {
          "code": "97130",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "methodology": "fee schedule"
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            {
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              "estimated_amount": 15.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
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              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "estimated_amount": 15.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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            },
            {
              "payer_name": "Aetna Network Services",
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              "estimated_amount": 15.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Joint Claims Administration",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
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            },
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              "payer_name": "Aetna Network Services",
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            },
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              "payer_name": "Aetna Network Services",
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            {
              "payer_name": "Aetna Network Services",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 20.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 20.41,
              "methodology": "fee schedule"
            },
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              "payer_name": "AlterNet Medical Services",
              "plan_name": "Group Health and Wellness Plans",
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              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
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              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 20.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 20.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 20.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 20.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 20.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15.8,
          "maximum": 114
        }
      ]
    },
    {
      "description": "Aquatic therapy/exercises",
      "code_information": [
        {
          "code": "97113",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "plan_name": "HMO",
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              "methodology": "fee schedule"
            },
            {
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            },
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              "estimated_amount": 26.66,
              "methodology": "fee schedule"
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              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Managed Choice POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "estimated_amount": 26.66,
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            },
            {
              "payer_name": "Aetna Network Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "indemnity plans with network incentives",
              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Signature Administrators®",
              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Joint Claims Administration",
              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Passport to Healthcare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "National Advantage Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Group Health and Wellness Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Health Maintenance Organization Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Self-funded Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Insurance Company Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 65,
              "methodology": "fee schedule"
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            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 35.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicaid",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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            },
            {
              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Devoted Health",
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            {
              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
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            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 38.75,
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
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            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 38.75,
              "methodology": "fee schedule"
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            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 38.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 38.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP RSA",
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              "estimated_amount": 38.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 35.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 35.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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            },
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              "payer_name": "Medicaid (State)",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
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          ],
          "minimum": 26.66,
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      ]
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    {
      "description": "Oral function therapy",
      "code_information": [
        {
          "code": "92526",
          "type": "HCPCS"
        }
      ],
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          "setting": "outpatient",
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              "payer_name": "Aetna Network Services",
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            {
              "payer_name": "Aetna Network Services",
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            },
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            },
            {
              "payer_name": "Aetna Network Services",
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            },
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              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Aetna Network Services",
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              "estimated_amount": 79.33,
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            },
            {
              "payer_name": "Aetna Network Services",
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              "estimated_amount": 80.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 80.63,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 80.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Group Health and Wellness Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Health Maintenance Organization Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Self-funded Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Superior HealthPlan",
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            },
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              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Superior HealthPlan",
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            },
            {
              "payer_name": "Devoted Health",
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            },
            {
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              "estimated_amount": 80.63,
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            {
              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 129.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 129.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 129.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 129.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 80.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 76.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 80.63,
              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "methodology": "fee schedule"
            },
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            },
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              "payer_name": "Medicaid (State)",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 76.6,
          "maximum": 260
        }
      ]
    },
    {
      "description": "Ot eval mod complex 45 min",
      "code_information": [
        {
          "code": "97166",
          "type": "HCPCS"
        }
      ],
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            },
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            },
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            },
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "methodology": "fee schedule"
            },
            {
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              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Insurance Company Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 95.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 95.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "CHIP",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "STAR Kids",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP MCO",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP Perinatal",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP RSA",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 92.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 92.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 97.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 72.99,
          "maximum": 260
        }
      ]
    },
    {
      "description": "Ther ivntj 1st 15 min",
      "code_information": [
        {
          "code": "97129",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "HMO",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "EPO",
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              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
            {
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              "standard_charge_percentage": 100,
              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
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              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "indemnity plans with network incentives",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Signature Administrators®",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Joint Claims Administration",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Aetna Network Services",
              "plan_name": "Passport to Healthcare",
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              "estimated_amount": 16.55,
              "methodology": "fee schedule"
            },
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              "payer_name": "Aetna Network Services",
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              "estimated_amount": 16.55,
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            },
            {
              "payer_name": "Aetna Network Services",
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              "estimated_amount": 21.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 21.27,
              "methodology": "fee schedule"
            },
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              "payer_name": "AlterNet Medical Services",
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              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
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              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
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              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 21.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 21.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 21.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 21.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16.55,
          "maximum": 114
        }
      ]
    },
    {
      "description": "Pt eval low complex 20 min",
      "code_information": [
        {
          "code": "97161",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "methodology": "fee schedule"
            },
            {
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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            },
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            },
            {
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              "methodology": "fee schedule"
            },
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              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
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            },
            {
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            },
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              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Signature Administrators®",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Joint Claims Administration",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "National Advantage Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Group Health and Wellness Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Health Maintenance Organization Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Insurance Company Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 93.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 93.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "CHIP",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "STAR Kids",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP MCO",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP Perinatal",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.19,
              "methodology": "fee schedule"
            },
            {
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
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              "estimated_amount": 90.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
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              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 95.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 72.51,
          "maximum": 260
        }
      ]
    },
    {
      "description": "Self care mngment training",
      "code_information": [
        {
          "code": "97535",
          "type": "HCPCS"
        }
      ],
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            },
            {
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            },
            {
              "payer_name": "Aetna Network Services",
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            },
            {
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            },
            {
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Signature Administrators®",
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            },
            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Aetna Network Services",
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            },
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            },
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            },
            {
              "payer_name": "Aetna Network Services",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 31.06,
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            },
            {
              "payer_name": "AlterNet Medical Services",
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              "estimated_amount": 100,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Health Maintenance Organization Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 100,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Self-funded Plans",
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              "estimated_amount": 100,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
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              "estimated_amount": 100,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
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              "estimated_amount": 100,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "estimated_amount": 100,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 30.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 31.06,
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            },
            {
              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP MCO",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP Perinatal",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 31.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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            },
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            },
            {
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            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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            },
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            },
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 100,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 100,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23.73,
          "maximum": 100
        }
      ]
    },
    {
      "description": "Speech sound lang comprehen",
      "code_information": [
        {
          "code": "92523",
          "type": "HCPCS"
        }
      ],
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            },
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            },
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            },
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            },
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            {
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            },
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              "payer_name": "Molina Healthcare of Texas",
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            },
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            },
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              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP RSA",
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              "estimated_amount": 169.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 218.02,
              "methodology": "fee schedule"
            },
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              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 207.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 207.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 218.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
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              "estimated_amount": 218.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 218.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 218.02,
              "methodology": "fee schedule"
            },
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              "payer_name": "Medicaid (State)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 325,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 325,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 153.36,
          "maximum": 325
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      ]
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    {
      "description": "Pt eval high complex 45 min",
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        {
          "code": "97163",
          "type": "HCPCS"
        }
      ],
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          "setting": "outpatient",
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            },
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            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
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              "estimated_amount": 72.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "estimated_amount": 72.51,
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            },
            {
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              "plan_name": "Aetna Signature Administrators®",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
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              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 260,
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            },
            {
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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            },
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              "payer_name": "Superior HealthPlan",
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            },
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              "methodology": "fee schedule"
            },
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              "payer_name": "Superior HealthPlan",
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              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
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              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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            },
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            },
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "methodology": "fee schedule"
            },
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            },
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            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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            },
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            },
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 72.51,
          "maximum": 260
        }
      ]
    },
    {
      "description": "Evaluate swallowing function",
      "code_information": [
        {
          "code": "92610",
          "type": "HCPCS"
        }
      ],
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            },
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            },
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              "methodology": "fee schedule"
            },
            {
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            },
            {
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            },
            {
              "payer_name": "AlterNet Medical Services",
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            },
            {
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            },
            {
              "payer_name": "Superior HealthPlan",
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            },
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              "payer_name": "Superior HealthPlan",
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            },
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              "payer_name": "Superior HealthPlan",
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            },
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              "methodology": "fee schedule"
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              "payer_name": "Molina Healthcare of Texas",
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            },
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              "standard_charge_percentage": 100,
              "estimated_amount": 205.12,
              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP RSA",
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              "estimated_amount": 205.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 64.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
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              "estimated_amount": 64.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
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              "estimated_amount": 67.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 67.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
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              "estimated_amount": 205.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 1007.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 1007.75,
              "methodology": "fee schedule"
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          ],
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      ]
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    {
      "description": "Ot eval low complex 30 min",
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        {
          "code": "97165",
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        }
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          "setting": "outpatient",
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              "methodology": "fee schedule"
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              "methodology": "fee schedule"
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              "methodology": "fee schedule"
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              "methodology": "fee schedule"
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            },
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              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
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            {
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            },
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            },
            {
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            {
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              "payer_name": "Aetna Network Services",
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              "payer_name": "Aetna Network Services",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
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            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
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              "payer_name": "AlterNet Medical Services",
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            },
            {
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            {
              "payer_name": "AlterNet Medical Services",
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              "methodology": "fee schedule"
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            {
              "payer_name": "AlterNet Medical Services",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
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            },
            {
              "payer_name": "AlterNet Medical Services",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Superior HealthPlan",
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            },
            {
              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Superior HealthPlan",
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            },
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              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Devoted Health",
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            {
              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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            },
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              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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            },
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            },
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 72.99,
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      ]
    },
    {
      "description": "Cognitive test by hc pro",
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        {
          "code": "96125",
          "type": "HCPCS"
        }
      ],
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            {
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            },
            {
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            {
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            {
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              "payer_name": "Molina Healthcare of Texas",
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            },
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              "methodology": "fee schedule"
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    },
    {
      "description": "Ot eval high complex 60 min",
      "code_information": [
        {
          "code": "97167",
          "type": "HCPCS"
        }
      ],
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    {
      "description": "Orthotic mgmt&traing 1st enc",
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    },
    {
      "description": "Ot re-eval est plan care",
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        {
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        }
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            },
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            },
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              "payer_name": "Medicaid (State)",
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            },
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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            }
          ],
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          "maximum": 260
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      ]
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    {
      "description": "Orthc/prostc mgmt sbsq enc",
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        {
          "code": "97763",
          "type": "HCPCS"
        }
      ],
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        {
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            {
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            },
            {
              "payer_name": "Aetna Network Services",
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            },
            {
              "payer_name": "Aetna Network Services",
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              "estimated_amount": 50.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
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              "estimated_amount": 50.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "indemnity plans with network incentives",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Signature Administrators®",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Joint Claims Administration",
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              "estimated_amount": 50.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
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              "estimated_amount": 50.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Passport to Healthcare",
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              "estimated_amount": 50.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "National Advantage Program",
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              "estimated_amount": 50.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
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              "estimated_amount": 49.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Group Health and Wellness Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 81.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Health Maintenance Organization Plans",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Self-funded Plans",
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              "estimated_amount": 81.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
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              "estimated_amount": 81.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
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              "estimated_amount": 81.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Insurance Company Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 81.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 49.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 49.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "CHIP",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star",
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              "estimated_amount": 35.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP MCO",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 35.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP RSA",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 49.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
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              "estimated_amount": 49.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
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              "estimated_amount": 81.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 81.24,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35.66,
          "maximum": 81.24
        }
      ]
    },
    {
      "description": "Pt re-eval est plan care",
      "code_information": [
        {
          "code": "97164",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
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              "payer_name": "Aetna Network Services",
              "plan_name": "HMO",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
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              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Managed Choice POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Choice POS II",
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              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
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              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "indemnity plans with network incentives",
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              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Signature Administrators®",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Joint Claims Administration",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Passport to Healthcare",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "National Advantage Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Group Health and Wellness Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Health Maintenance Organization Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Self-funded Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Association Health Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Austin Resolutions' Client Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "AlterNet Medical Services",
              "plan_name": "Insurance Company Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 64.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 64.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "CHIP",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "STAR Kids",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP MCO",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP Perinatal",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "CHIP RSA",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 62.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 62.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 49.93,
          "maximum": 260
        }
      ]
    },
    {
      "description": "Sensory integration",
      "code_information": [
        {
          "code": "97533",
          "type": "HCPCS"
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "Workers' Compensation",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "HMO",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "PPO",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "EPO",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "POS",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "QPOS",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Elect Choice",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Open Choice",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Managed Choice POS",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Choice POS II",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Select",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "indemnity plans with network incentives",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Signature Administrators®",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Joint Claims Administration",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Passport to Healthcare",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "National Advantage Program",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "Traditional Indemnity",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "Blue Essentials",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "HealthSelect",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Workers' Compensation",
              "standard_charge_dollar": 950,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Automobile Insurance",
              "standard_charge_dollar": 950,
              "methodology": "per diem"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Commercial-Exchange (ACA) HMO",
              "standard_charge_dollar": 875,
              "methodology": "per diem"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Commercial-Exchange (ACA) EPO",
              "standard_charge_dollar": 875,
              "methodology": "per diem"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicaid",
              "standard_charge_dollar": 850,
              "methodology": "per diem"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "CHIP",
              "standard_charge_dollar": 850,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Network Access",
              "standard_charge_dollar": 950,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "PPO",
              "standard_charge_dollar": 950,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "PPO",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "POS",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "Blue Advantage HMO",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "Commercial",
              "standard_charge_dollar": 1000,
              "methodology": "per diem"
            }
          ],
          "minimum": 850,
          "maximum": 2450
        }
      ]
    },
    {
      "description": "Room & Board - Ward - Rehabilitation",
      "code_information": [
        {
          "code": "0158",
          "type": "RC"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "Auto Liability",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "Liability",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "No Fault",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "Other Long-term Care Products",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "Workers' Compensation",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "HMO",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "PPO",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "EPO",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "POS",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "QPOS",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Elect Choice",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Open Choice",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Managed Choice POS",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Choice POS II",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Select",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Student Health",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "indemnity plans with network incentives",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Aetna Signature Administrators®",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Joint Claims Administration",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Meritain/Meritain Shared Administrative Services",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Passport to Healthcare",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "National Advantage Program",
              "standard_charge_dollar": 1003,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "Traditional Indemnity",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "Blue Essentials",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "HealthSelect",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Workers' Compensation",
              "standard_charge_dollar": 950,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Automobile Insurance",
              "standard_charge_dollar": 950,
              "methodology": "per diem"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Commercial-Exchange (ACA) HMO",
              "standard_charge_dollar": 875,
              "methodology": "per diem"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Commercial-Exchange (ACA) EPO",
              "standard_charge_dollar": 875,
              "methodology": "per diem"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicaid",
              "standard_charge_dollar": 850,
              "methodology": "per diem"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "CHIP",
              "standard_charge_dollar": 850,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Network Access",
              "standard_charge_dollar": 950,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "PPO",
              "standard_charge_dollar": 950,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "PPO",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "POS",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Blue Cross Blue Shield of Texas",
              "plan_name": "Blue Advantage HMO",
              "standard_charge_dollar": 1100,
              "methodology": "per diem"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "Commercial",
              "standard_charge_dollar": 1000,
              "methodology": "per diem"
            }
          ],
          "minimum": 850,
          "maximum": 2450
        }
      ]
    },
    {
      "description": "Stroke M >=72.50- Tier None",
      "code_information": [
        {
          "code": "A0101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 14043.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 14043.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 13613.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 13613.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 14330.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 13613.53,
          "maximum": 14330.03
        }
      ]
    },
    {
      "description": "Stroke M >=72.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18401.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18401.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17838.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17838.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18777.22,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17838.36,
          "maximum": 18777.22
        }
      ]
    },
    {
      "description": "Stroke M >=72.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16340.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16340.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15840.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15840.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16674.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15840.33,
          "maximum": 16674.03
        }
      ]
    },
    {
      "description": "Stroke M >=72.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 14804.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 14804.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 14351.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 14351.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 15106.83,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 14351.49,
          "maximum": 15106.83
        }
      ]
    },
    {
      "description": "Stroke M >=63.50 and M <72.50- Tier None",
      "code_information": [
        {
          "code": "A0102",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17874.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17874.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17327.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17327.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18239.28,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17327.32,
          "maximum": 18239.28
        }
      ]
    },
    {
      "description": "Stroke M >=63.50 and M <72.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0102",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23420.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23420.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22703.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22703.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23898.27,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22703.36,
          "maximum": 23898.27
        }
      ]
    },
    {
      "description": "Stroke M >=63.50 and M <72.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0102",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20797.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20797.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20161.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20161.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21222.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20161.09,
          "maximum": 21222.2
        }
      ]
    },
    {
      "description": "Stroke M >=63.50 and M <72.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0102",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18843.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18843.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18266.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18266.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19227.76,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18266.37,
          "maximum": 19227.76
        }
      ]
    },
    {
      "description": "Stroke M >=50.50 and M <63.50- Tier None",
      "code_information": [
        {
          "code": "A0103",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22944.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22944.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22242.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22242.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23412.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22242.13,
          "maximum": 23412.77
        }
      ]
    },
    {
      "description": "Stroke M >=50.50 and M <63.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0103",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30066.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30066.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29145.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29145.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30679.74,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29145.75,
          "maximum": 30679.74
        }
      ]
    },
    {
      "description": "Stroke M >=50.50 and M <63.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0103",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26699.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26699.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25882.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25882.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27244.34,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25882.12,
          "maximum": 27244.34
        }
      ]
    },
    {
      "description": "Stroke M >=50.50 and M <63.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0103",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24189.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24189.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23448.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23448.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24682.84,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23448.7,
          "maximum": 24682.84
        }
      ]
    },
    {
      "description": "Stroke M >=41.50 and M <50.50- Tier None",
      "code_information": [
        {
          "code": "A0104",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29304.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29304.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28407.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 28407.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 29902.94,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28407.79,
          "maximum": 29902.94
        }
      ]
    },
    {
      "description": "Stroke M >=41.50 and M <50.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0104",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 38400.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 38400.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 37224.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 37224.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39183.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 37224.58,
          "maximum": 39183.77
        }
      ]
    },
    {
      "description": "Stroke M >=41.50 and M <50.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0104",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 34100.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 34100.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 33056.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 33056.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34796.79,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33056.95,
          "maximum": 34796.79
        }
      ]
    },
    {
      "description": "Stroke M >=41.50 and M <50.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0104",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30895.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30895.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29950.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29950.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31526.46,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29950.14,
          "maximum": 31526.46
        }
      ]
    },
    {
      "description": "Stroke M <41.50 and A >=84.50- Tier None",
      "code_information": [
        {
          "code": "A0105",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 36521.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 36521.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 35403.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 35403.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 37267.01,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35403.66,
          "maximum": 37267.01
        }
      ]
    },
    {
      "description": "Stroke M <41.50 and A >=84.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0105",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 47963.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 47963.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 46495.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 46495.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 48942.63,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 46495.5,
          "maximum": 48942.63
        }
      ]
    },
    {
      "description": "Stroke M <41.50 and A >=84.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0105",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 42497.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 42497.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 41196.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 41196.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 43364.9,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 41196.66,
          "maximum": 43364.9
        }
      ]
    },
    {
      "description": "Stroke M <41.50 and A >=84.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0105",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 38502.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 38502.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 37324.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 37324.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39288.64,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 37324.21,
          "maximum": 39288.64
        }
      ]
    },
    {
      "description": "Stroke M <41.50 and A <84.50- Tier None",
      "code_information": [
        {
          "code": "A0106",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 41202.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 41202.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 39941.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 39941.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 42043.58,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39941.4,
          "maximum": 42043.58
        }
      ]
    },
    {
      "description": "Stroke M <41.50 and A <84.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0106",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 54554.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 54554.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 52884.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 52884.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 55667.38,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 52884.01,
          "maximum": 55667.38
        }
      ]
    },
    {
      "description": "Stroke M <41.50 and A <84.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0106",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 47870.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 47870.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 46404.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 46404.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 48847.17,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 46404.81,
          "maximum": 48847.17
        }
      ]
    },
    {
      "description": "Stroke M <41.50 and A <84.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0106",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 43371.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 43371.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 42043.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 42043.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 44256.28,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42043.47,
          "maximum": 44256.28
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=73.50- Tier None",
      "code_information": [
        {
          "code": "A0201",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 13786.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 13786.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 13364.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 13364.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 14067.86,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 13364.47,
          "maximum": 14067.86
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=73.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0201",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20200.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20200.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19581.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19581.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20612.41,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19581.79,
          "maximum": 20612.41
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=73.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0201",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16062.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16062.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15570.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15570.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16390.5,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15570.98,
          "maximum": 16390.5
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=73.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0201",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 14673.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 14673.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 14224.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 14224.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 14972.83,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 14224.19,
          "maximum": 14972.83
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=61.50 and M <73.50- Tier None",
      "code_information": [
        {
          "code": "A0202",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18003.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18003.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17452.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17452.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18371.34,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17452.77,
          "maximum": 18371.34
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=61.50 and M <73.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0202",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26379.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26379.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25572.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25572.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25572.19,
          "maximum": 26918.09
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=61.50 and M <73.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0202",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20974.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20974.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20332.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20332.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21402.8,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20332.66,
          "maximum": 21402.8
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=61.50 and M <73.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0202",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19162.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19162.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18576.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18576.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19554.02,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18576.32,
          "maximum": 19554.02
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=49.50 and M <61.50- Tier None",
      "code_information": [
        {
          "code": "A0203",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22383.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22383.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21697.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21697.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22839.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21697.89,
          "maximum": 22839.88
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=49.50 and M <61.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0203",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32797.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32797.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31793.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31793.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33466.52,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31793.19,
          "maximum": 33466.52
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=49.50 and M <61.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0203",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26077.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26077.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25278.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25278.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26609.31,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25278.84,
          "maximum": 26609.31
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=49.50 and M <61.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0203",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23823.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23823.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23094.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23094.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24309.98,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23094.48,
          "maximum": 24309.98
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=35.50 and M <49.50- Tier None",
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        {
          "code": "A0204",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
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              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
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              "estimated_amount": 27586.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27586.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26741.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26741.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 28149.32,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26741.85,
          "maximum": 28149.32
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      ]
    },
    {
      "description": "Traumatic brain injury M >=35.50 and M <49.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0204",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 40421.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 40421.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 41246.18,
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            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 39183.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 39183.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
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              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 41246.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 41246.18,
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            }
          ],
          "minimum": 39183.87,
          "maximum": 41246.18
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      ]
    },
    {
      "description": "Traumatic brain injury M >=35.50 and M <49.50- Tier Tier 2",
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        {
          "code": "C0204",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
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              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 32794.58,
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 32138.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 32138.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 32794.58,
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            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31154.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31154.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32794.58,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31154.85,
          "maximum": 32794.58
        }
      ]
    },
    {
      "description": "Traumatic brain injury M >=35.50 and M <49.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0204",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29361.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29361.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28463.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 28463.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 29961.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28463.14,
          "maximum": 29961.2
        }
      ]
    },
    {
      "description": "Traumatic brain injury M <35.50- Tier None",
      "code_information": [
        {
          "code": "A0205",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35391.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35391.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34307.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 36113.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34307.8,
          "maximum": 36113.47
        }
      ]
    },
    {
      "description": "Traumatic brain injury M <35.50- Tier Tier 1",
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        {
          "code": "B0205",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 51857.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 51857.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 50269.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 50269.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 52915.66,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 50269.88,
          "maximum": 52915.66
        }
      ]
    },
    {
      "description": "Traumatic brain injury M <35.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0205",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 41232,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 41232,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 39969.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 39969.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42073.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39969.8,
          "maximum": 42073.47
        }
      ]
    },
    {
      "description": "Traumatic brain injury M <35.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0205",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 37669.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 37669.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 36516.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 36516.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 38438.04,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 36516.14,
          "maximum": 38438.04
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=65.50- Tier None",
      "code_information": [
        {
          "code": "A0301",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
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              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
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              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 15718.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 15718.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 15237.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 15237.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 16038.99,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15237.04,
          "maximum": 16038.99
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      ]
    },
    {
      "description": "Non-traumatic brain injury M >=65.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0301",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22721.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22721.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22026.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22026.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23185.56,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22026.28,
          "maximum": 23185.56
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=65.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0301",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18007.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18007.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17456.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17456.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18375.22,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17456.46,
          "maximum": 18375.22
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=65.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0301",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16789.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16789.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 16275.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 16275.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17132.34,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16275.72,
          "maximum": 17132.34
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=52.50 and M <65.50- Tier None",
      "code_information": [
        {
          "code": "A0302",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20331.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20331.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19709.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19709.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20746.41,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19709.09,
          "maximum": 20746.41
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=52.50 and M <65.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0302",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29394.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29394.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28494.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 28494.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 29994.22,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28494.51,
          "maximum": 29994.22
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=52.50 and M <65.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0302",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23296.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23296.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22583.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22583.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23772.04,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22583.44,
          "maximum": 23772.04
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=52.50 and M <65.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0302",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21718.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21718.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21054.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21054.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22162.12,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21054.01,
          "maximum": 22162.12
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=42.50 and M <52.50- Tier None",
      "code_information": [
        {
          "code": "A0303",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24245.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24245.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23503.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23503.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24740.42,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23503.4,
          "maximum": 24740.42
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=42.50 and M <52.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0303",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35002.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35002.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 33931.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 33931.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35717.22,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33931.36,
          "maximum": 35717.22
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=42.50 and M <52.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0303",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28003.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28003.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27146.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27146.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28574.93,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27146.18,
          "maximum": 28574.93
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M >=42.50 and M <52.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0303",
          "type": "LOCAL"
        }
      ],
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            },
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            },
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            },
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              "payer_name": "Molina Healthcare of Texas",
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            },
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            },
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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            },
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              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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            },
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              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Medicare (CMS)",
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            }
          ],
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        }
      ]
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    {
      "description": "Non-traumatic brain injury M <42.50 and A >=78.50- Tier None",
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        {
          "code": "A0304",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "estimated_amount": 29062.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 29062.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
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              "estimated_amount": 29062.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 29062.06,
              "methodology": "fee schedule"
            },
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              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 28480.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28480.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 29062.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 29062.06,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 29062.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 29062.06,
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            },
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              "payer_name": "Molina Healthcare of Texas",
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            },
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 27608.96,
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            },
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              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "WellPoint fka AmeriGroup Texas",
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            },
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              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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            },
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            },
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            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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            },
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            }
          ],
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          "maximum": 29062.06
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      ]
    },
    {
      "description": "Non-traumatic brain injury M <42.50 and A >=78.50- Tier Tier 1",
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        {
          "code": "B0304",
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        }
      ],
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        {
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 42015.21,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 42015.21,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 42015.21,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 41174.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 41174.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 42015.21,
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            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 39914.45,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 39914.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 42015.21,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39914.45,
          "maximum": 42015.21
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M <42.50 and A >=78.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0304",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32633.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32633.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 31634.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 31634.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33299.5,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31634.53,
          "maximum": 33299.5
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M <42.50 and A >=78.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0304",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30422.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30422.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29490.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29490.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31042.9,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29490.76,
          "maximum": 31042.9
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M <42.50 and A <78.50- Tier None",
      "code_information": [
        {
          "code": "A0305",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 31198.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 31198.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 30243.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 30243.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31835.24,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30243.48,
          "maximum": 31835.24
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M <42.50 and A <78.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0305",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 45103.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 45103.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 43722.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 43722.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 46023.5,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 43722.33,
          "maximum": 46023.5
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M <42.50 and A <78.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0305",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35808.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35808.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34711.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34711.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36538.9,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34711.96,
          "maximum": 36538.9
        }
      ]
    },
    {
      "description": "Non-traumatic brain injury M <42.50 and A <78.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0305",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 33326.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 33326.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 32306.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 32306.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34006.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32306.07,
          "maximum": 34006.39
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=56.50- Tier None",
      "code_information": [
        {
          "code": "A0401",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18569.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18569.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18000.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18000.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18948.11,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18000.7,
          "maximum": 18948.11
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=56.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0401",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25784.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25784.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24994.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24994.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26310.24,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24994.73,
          "maximum": 26310.24
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=56.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0401",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21075.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21075.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20430.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20430.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21505.73,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20430.44,
          "maximum": 21505.73
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=56.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0401",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20521.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20521.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19893.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19893.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20940.61,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19893.58,
          "maximum": 20940.61
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=47.50 and M <56.50- Tier None",
      "code_information": [
        {
          "code": "A0402",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23279.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23279.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22566.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22566.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23754.57,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22566.84,
          "maximum": 23754.57
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=47.50 and M <56.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0402",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32325.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32325.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31335.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31335.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32984.9,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31335.66,
          "maximum": 32984.9
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=47.50 and M <56.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0402",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26421.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26421.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25612.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25612.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26960.81,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25612.77,
          "maximum": 26960.81
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=47.50 and M <56.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0402",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25726.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25726.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24939.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24939.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26251.98,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24939.38,
          "maximum": 26251.98
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=41.50 and M <47.50- Tier None",
      "code_information": [
        {
          "code": "A0403",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28739.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28739.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27859.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27859.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 29325.74,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27859.45,
          "maximum": 29325.74
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=41.50 and M <47.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0403",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 37309.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 37309.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 36167.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 36167.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 38071,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 36167.45,
          "maximum": 38071
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=41.50 and M <47.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0403",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32581.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32581.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31584.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31584.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33246.44,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31584.12,
          "maximum": 33246.44
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=41.50 and M <47.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0403",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 31627.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 31627.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 30659.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 30659.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32273.44,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30659.77,
          "maximum": 32273.44
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M <31.50 and A <61.50- Tier None",
      "code_information": [
        {
          "code": "A0404",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 44872.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 44872.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 43498.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 43498.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 45788.07,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 43498.67,
          "maximum": 45788.07
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M <31.50 and A <61.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0404",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 60453.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 60453.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 58603.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 58603.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 61687.69,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 58603.31,
          "maximum": 61687.69
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M <31.50 and A <61.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0404",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 50871.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 50871.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 49314.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 49314.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 51909.49,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 49314.02,
          "maximum": 51909.49
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M <31.50 and A <61.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0404",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 49382.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 49382.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 47871.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 47871.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 50390.62,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 47871.09,
          "maximum": 50390.62
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=31.50 and M <41.50- Tier None",
      "code_information": [
        {
          "code": "A0405",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35684.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35684.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34591.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34591.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36412.49,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34591.87,
          "maximum": 36412.49
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=31.50 and M <41.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0405",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 47885.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 47885.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 46419.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 46419.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 48862.71,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 46419.57,
          "maximum": 48862.71
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=31.50 and M <41.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0405",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 40455.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 40455.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 39217.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 39217.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 41281.28,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39217.22,
          "maximum": 41281.28
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=31.50 and M <41.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0405",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 39271.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 39271.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 38069.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 38069.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 40072.7,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 38069.07,
          "maximum": 40072.7
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50- Tier None",
      "code_information": [
        {
          "code": "A0406",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 45533.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 45533.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 44139.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 44139.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 46462.27,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 44139.16,
          "maximum": 46462.27
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0406",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 62994.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 62994.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 61066.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 61066.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 64280.26,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 61066.25,
          "maximum": 64280.26
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0406",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 51620.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 51620.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 50040.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 50040.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 52673.71,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 50040.02,
          "maximum": 52673.71
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0406",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 50134.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 50134.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 48600.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 48600.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 51158.15,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 48600.24,
          "maximum": 51158.15
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M <24.50 and A >=61.50- Tier None",
      "code_information": [
        {
          "code": "A0407",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 62247.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 62247.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 60342.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 60342.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 63518.35,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 60342.43,
          "maximum": 63518.35
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M <24.50 and A >=61.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0407",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 86266.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 86266.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 83625.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 83625.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 88027.06,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 83625.71,
          "maximum": 88027.06
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M <24.50 and A >=61.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0407",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 70570.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 70570.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 68410.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 68410.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 72010.96,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 68410.41,
          "maximum": 72010.96
        }
      ]
    },
    {
      "description": "Traumatic spinal cord injury M <24.50 and A >=61.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0407",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 68656.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 68656.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 66554.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 66554.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 70057.71,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 66554.82,
          "maximum": 70057.71
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=60.50- Tier None",
      "code_information": [
        {
          "code": "A0501",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16414.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16414.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15912.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15912.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16749.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15912.28,
          "maximum": 16749.77
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=60.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0501",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24912.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24912.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24149.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24149.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25420.8,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24149.76,
          "maximum": 25420.8
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=60.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0501",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19145.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19145.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18559.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18559.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19536.54,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18559.71,
          "maximum": 19536.54
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=60.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0501",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17811.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17811.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17266.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17266.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18175.19,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17266.43,
          "maximum": 18175.19
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=53.50 and M <60.50- Tier None",
      "code_information": [
        {
          "code": "A0502",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20377.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20377.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19753.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19753.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20793.01,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19753.36,
          "maximum": 20793.01
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=53.50 and M <60.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0502",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30928.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30928.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29981.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29981.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31559.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29981.5,
          "maximum": 31559.47
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=53.50 and M <60.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0502",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23768.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23768.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23040.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23040.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24253.66,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23040.98,
          "maximum": 24253.66
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=53.50 and M <60.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0502",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22110.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22110.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21434.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21434.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22562.18,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21434.07,
          "maximum": 22562.18
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=48.50 and M <53.50- Tier None",
      "code_information": [
        {
          "code": "A0503",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23215.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23215.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22504.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22504.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23688.9,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22504.46,
          "maximum": 23688.9
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=48.50 and M <53.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0503",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35021.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35021.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 33949.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 33949.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35736.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33949.88,
          "maximum": 35736.72
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=48.50 and M <53.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0503",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26914.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26914.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26090.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26090.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27463.79,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26090.6,
          "maximum": 27463.79
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=48.50 and M <53.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0503",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25191.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25191.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24420.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24420.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25705.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24420.46,
          "maximum": 25705.75
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=39.50 and M <48.50- Tier None",
      "code_information": [
        {
          "code": "A0504",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27596.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27596.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26751.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26751.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28159.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26751.34,
          "maximum": 28159.3
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=39.50 and M <48.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0504",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 41848.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 41848.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 40567.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 40567.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 42702.68,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 40567.55,
          "maximum": 42702.68
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=39.50 and M <48.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0504",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32159.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32159.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31175.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31175.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32815.95,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31175.15,
          "maximum": 32815.95
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=39.50 and M <48.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0504",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29946.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29946.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29029.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29029.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30557.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29029.44,
          "maximum": 30557.3
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M <39.50- Tier None",
      "code_information": [
        {
          "code": "A0505",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 39174.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 39174.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 37975.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 37975.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39974.16,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 37975.45,
          "maximum": 39974.16
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M <39.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0505",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 59458.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 59458.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 57638.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 57638.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 60672.02,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 57638.42,
          "maximum": 60672.02
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M <39.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0505",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 45693.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 45693.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 44294.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 44294.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 46625.52,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 44294.24,
          "maximum": 46625.52
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M <39.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0505",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 42509.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 42509.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 41207.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 41207.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 43376.55,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 41207.72,
          "maximum": 43376.55
        }
      ]
    },
    {
      "description": "Neurological M >=64.50- Tier None",
      "code_information": [
        {
          "code": "A0601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 15967.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 15967.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15478.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15478.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16293.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15478.72,
          "maximum": 16293.39
        }
      ]
    },
    {
      "description": "Neurological M >=64.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24940.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24940.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24176.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24176.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25449.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24176.64,
          "maximum": 25449.09
        }
      ]
    },
    {
      "description": "Neurological M >=64.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18875.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18875.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18297.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18297.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19260.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18297.73,
          "maximum": 19260.77
        }
      ]
    },
    {
      "description": "Neurological M >=64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17777.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17777.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17233.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17233.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18140.24,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17233.23,
          "maximum": 18140.24
        }
      ]
    },
    {
      "description": "Neurological M >=52.50 and M <64.50- Tier None",
      "code_information": [
        {
          "code": "A0602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19939.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19939.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19329.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19329.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20346.63,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19329.3,
          "maximum": 20346.63
        }
      ]
    },
    {
      "description": "Neurological M >=52.50 and M <64.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 31633.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 31633.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 30665.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 30665.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32279.19,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30665.23,
          "maximum": 32279.19
        }
      ]
    },
    {
      "description": "Neurological M >=52.50 and M <64.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23684.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23684.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22959.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22959.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24167.73,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22959.34,
          "maximum": 24167.73
        }
      ]
    },
    {
      "description": "Neurological M >=52.50 and M <64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22112.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22112.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21435.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21435.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22564.12,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21435.91,
          "maximum": 22564.12
        }
      ]
    },
    {
      "description": "Neurological M >=43.50 and M <52.50- Tier None",
      "code_information": [
        {
          "code": "A0603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23620.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23620.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22897.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22897.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24102.18,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22897.07,
          "maximum": 24102.18
        }
      ]
    },
    {
      "description": "  Neurological M >=43.50 and M <52.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 37274.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 37274.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 36133.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 36133.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 38034.78,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 36133.04,
          "maximum": 38034.78
        }
      ]
    },
    {
      "description": "Neurological M >=43.50 and M <52.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27919.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27919.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27064.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27064.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28489.17,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27064.71,
          "maximum": 28489.17
        }
      ]
    },
    {
      "description": "Neurological M >=43.50 and M <52.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26295.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26295.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25491.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25491.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26832.64,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25491.01,
          "maximum": 26832.64
        }
      ]
    },
    {
      "description": "Neurological M <43.50- Tier None",
      "code_information": [
        {
          "code": "A0604",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29872.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29872.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28957.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 28957.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30481.66,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28957.58,
          "maximum": 30481.66
        }
      ]
    },
    {
      "description": "Neurological M <43.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0604",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 46745.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 46745.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 45314.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 45314.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 47699.58,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 45314.6,
          "maximum": 47699.58
        }
      ]
    },
    {
      "description": "Neurological M <43.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0604",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35309.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35309.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34228.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34228.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36029.96,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34228.46,
          "maximum": 36029.96
        }
      ]
    },
    {
      "description": "Neurological M <43.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0604",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 33257.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 33257.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 32239.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 32239.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33936.48,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32239.66,
          "maximum": 33936.48
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=61.50- Tier None",
      "code_information": [
        {
          "code": "A0701",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16201.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16201.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 15705.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 15705.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16532.26,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15705.65,
          "maximum": 16532.26
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=61.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0701",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23541.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23541.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 22821.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22821.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24022.17,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22821.06,
          "maximum": 24022.17
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=61.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0701",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18668.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18668.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18096.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18096.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19049.1,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18096.65,
          "maximum": 19049.1
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=61.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0701",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17729.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17729.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17187.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17187.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18091.69,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17187.11,
          "maximum": 18091.69
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=52.50 and M <61.50- Tier None",
      "code_information": [
        {
          "code": "A0702",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20026.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20026.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19413.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19413.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20435.68,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19413.9,
          "maximum": 20435.68
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=52.50 and M <61.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0702",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29078.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29078.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28188.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 28188.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 29672.41,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28188.79,
          "maximum": 29672.41
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=52.50 and M <61.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0702",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23075.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23075.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22369.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22369.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23546.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22369.43,
          "maximum": 23546.77
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=52.50 and M <61.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0702",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21914.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21914.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21244.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21244.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22362.15,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21244.04,
          "maximum": 22362.15
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=41.50 and M <52.50- Tier None",
      "code_information": [
        {
          "code": "A0703",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24535.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24535.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23784.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23784.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25036.29,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23784.48,
          "maximum": 25036.29
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=41.50 and M <52.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0703",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35759.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35759.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34664.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34664.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36489.1,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34664.65,
          "maximum": 36489.1
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=41.50 and M <52.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0703",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28269.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28269.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27404.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27404.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28846.49,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27404.17,
          "maximum": 28846.49
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M >=41.50 and M <52.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0703",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26849.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26849.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26027.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26027.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27397.76,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26027.87,
          "maximum": 27397.76
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M <41.50- Tier None",
      "code_information": [
        {
          "code": "A0704",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30294.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30294.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29367.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29367.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30912.78,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29367.14,
          "maximum": 30912.78
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M <41.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0704",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 43684.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 43684.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 42346.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 42346.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 44575.66,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42346.88,
          "maximum": 44575.66
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M <41.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0704",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
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              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 34907.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 34907.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 33839.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
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              "estimated_amount": 33839.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35620.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33839.19,
          "maximum": 35620.2
        }
      ]
    },
    {
      "description": "Fracture of lower extremity M <41.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0704",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 33153.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
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              "estimated_amount": 33153.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 32138.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
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              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33829.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32138.19,
          "maximum": 33829.67
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=63.50- Tier None",
      "code_information": [
        {
          "code": "A0801",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 15815.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
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              "estimated_amount": 15815.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 15331.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 15331.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16138.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15331.13,
          "maximum": 16138.03
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=63.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0801",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22819.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22819.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 22120.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 22120.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23284.76,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22120.52,
          "maximum": 23284.76
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=63.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0801",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18883.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18883.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18305.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18305.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19268.54,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18305.11,
          "maximum": 19268.54
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=63.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0801",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16879.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16879.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 16362.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 16362.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17223.61,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16362.43,
          "maximum": 17223.61
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=57.50 and M <63.50- Tier None",
      "code_information": [
        {
          "code": "A0802",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18026.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18026.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17474.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17474.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18394.64,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17474.91,
          "maximum": 18394.64
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=57.50 and M <63.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0802",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25871.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25871.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25079.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25079.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26399.1,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25079.15,
          "maximum": 26399.1
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=57.50 and M <63.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0802",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21524.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21524.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20865.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20865.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21964.04,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20865.84,
          "maximum": 21964.04
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=57.50 and M <63.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0802",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19239.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19239.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18650.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18650.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19631.7,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18650.12,
          "maximum": 19631.7
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=51.50 and M <57.50- Tier None",
      "code_information": [
        {
          "code": "A0803",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19838.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19838.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19231.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19231.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20243.43,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19231.26,
          "maximum": 20243.43
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=51.50 and M <57.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0803",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28795.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28795.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27914.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27914.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27914.04,
          "maximum": 29383.2
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=51.50 and M <57.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0803",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23688.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23688.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22963.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22963.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24172.1,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22963.5,
          "maximum": 24172.1
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=51.50 and M <57.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0803",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21174.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21174.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20526.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20526.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 21606.71,
              "methodology": "fee schedule"
            },
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              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 21606.71,
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      ]
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    {
      "description": "Replacement of lower-extremity joint M >=42.50 and M <51.50- Tier None",
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        {
          "code": "A0804",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 22997.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 22537.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 22537.25,
              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 22997.19,
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 22997.19,
              "methodology": "fee schedule"
            },
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              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 22997.19,
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            }
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      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=42.50 and M <51.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0804",
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        }
      ],
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        {
          "setting": "inpatient",
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              "plan_name": "Medicare Advantage",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 32918.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 32260.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 32260.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 32918.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 32918.91,
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            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 32918.91,
              "methodology": "fee schedule"
            },
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              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
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            },
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 32918.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 32918.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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            }
          ],
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        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=42.50 and M <51.50- Tier Tier 2",
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        {
          "code": "C0804",
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        }
      ],
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        {
          "setting": "inpatient",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
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            {
              "payer_name": "Humana Insurance Company",
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            },
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            },
            {
              "payer_name": "Superior HealthPlan",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 26910.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 27459.91,
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            },
            {
              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 26086.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 27459.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 27459.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 27459.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 27459.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 27459.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 27459.91,
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            }
          ],
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          "maximum": 27459.91
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M >=42.50 and M <51.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0804",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 24054.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 24054.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23317.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23317.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 24544.96,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23317.71,
          "maximum": 24544.96
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M <42.50- Tier None",
      "code_information": [
        {
          "code": "A0805",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 28069.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28069.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27210.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 27210.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28642.58,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27210.45,
          "maximum": 28642.58
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M <42.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0805",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 39795.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 39795.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 38576.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 38576.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 40607.26,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 38576.9,
          "maximum": 40607.26
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M <42.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0805",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 33516.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 33516.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 32490.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 32490.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34200.59,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32490.56,
          "maximum": 34200.59
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M <42.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0805",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29959.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29959.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29042.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29042.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30570.99,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29042.44,
          "maximum": 30570.99
        }
      ]
    },
    {
      "description": "Other orthopedic M >=63.50- Tier None",
      "code_information": [
        {
          "code": "A0901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 15406.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 15406.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 14935.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 14935.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 15721.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 14935.04,
          "maximum": 15721.09
        }
      ]
    },
    {
      "description": "Other orthopedic M >=63.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23570.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23570.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22849.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22849.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24051.69,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22849.11,
          "maximum": 24051.69
        }
      ]
    },
    {
      "description": "Other orthopedic M >=63.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18066.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18066.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17513.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17513.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18435.13,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17513.37,
          "maximum": 18435.13
        }
      ]
    },
    {
      "description": "Other orthopedic M >=63.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16865.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16865.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 16349.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 16349.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17210.02,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16349.52,
          "maximum": 17210.02
        }
      ]
    },
    {
      "description": "Other orthopedic M >=51.50 and M <63.50- Tier None",
      "code_information": [
        {
          "code": "A0902",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19545.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19545.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18947.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18947.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19944.36,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18947.14,
          "maximum": 19944.36
        }
      ]
    },
    {
      "description": "Other orthopedic M >=51.50 and M <63.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0902",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29942.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29942.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29025.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29025.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30553.51,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29025.83,
          "maximum": 30553.51
        }
      ]
    },
    {
      "description": "Other orthopedic M >=51.50 and M <63.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0902",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22679.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22679.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21985.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21985.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23142.84,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21985.7,
          "maximum": 23142.84
        }
      ]
    },
    {
      "description": "Other orthopedic M >=51.50 and M <63.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0902",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21423.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21423.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20768.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20768.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21861.11,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20768.05,
          "maximum": 21861.11
        }
      ]
    },
    {
      "description": "Other orthopedic M >=44.50 and M <51.50- Tier None",
      "code_information": [
        {
          "code": "A0903",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23193.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23193.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22483.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22483.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23667.18,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22483.82,
          "maximum": 23667.18
        }
      ]
    },
    {
      "description": "Other orthopedic M >=44.50 and M <51.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0903",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35532.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35532.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34444.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34444.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36257.17,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34444.31,
          "maximum": 36257.17
        }
      ]
    },
    {
      "description": "Other orthopedic M >=44.50 and M <51.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0903",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26912.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26912.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26088.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26088.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27461.85,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26088.76,
          "maximum": 27461.85
        }
      ]
    },
    {
      "description": "Other orthopedic M >=44.50 and M <51.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0903",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25422.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25422.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24644.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24644.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25941.26,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24644.2,
          "maximum": 25941.26
        }
      ]
    },
    {
      "description": "Other orthopedic M <44.5- Tier None",
      "code_information": [
        {
          "code": "A0904",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27928.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27928.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27073.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27073.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28498.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27073.94,
          "maximum": 28498.88
        }
      ]
    },
    {
      "description": "Other orthopedic M <44.5- Tier Tier 1",
      "code_information": [
        {
          "code": "B0904",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 42786.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 42786.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 41477.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 41477.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 43660.08,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 41477.08,
          "maximum": 43660.08
        }
      ]
    },
    {
      "description": "Other orthopedic M <44.5- Tier Tier 2",
      "code_information": [
        {
          "code": "C0904",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32408.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32408.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31416.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31416.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33070.35,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31416.83,
          "maximum": 33070.35
        }
      ]
    },
    {
      "description": "Other orthopedic M <44.5- Tier Tier 3",
      "code_information": [
        {
          "code": "D0904",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30614.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30614.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29677.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29677.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31239.04,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29677.09,
          "maximum": 31239.04
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=64.50- Tier None",
      "code_information": [
        {
          "code": "A1001",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16376.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16376.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15875.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15875.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16710.93,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15875.38,
          "maximum": 16710.93
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=64.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1001",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23387.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23387.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22672,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22672,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23865.26,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22672,
          "maximum": 23865.26
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=64.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1001",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19433.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19433.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18838.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18838.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19829.78,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18838.29,
          "maximum": 19829.78
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1001",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17638.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17638.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17098.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17098.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17998.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17098.55,
          "maximum": 17998.47
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=55.50 and M <64.50- Tier None",
      "code_information": [
        {
          "code": "A1002",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19895.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19895.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19286.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19286.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20301.69,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19286.61,
          "maximum": 20301.69
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=55.50 and M <64.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1002",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28795.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28795.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27914.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27914.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 29383.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27914.04,
          "maximum": 29383.2
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=55.50 and M <64.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1002",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23813.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23813.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23084.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23084.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24299.89,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23084.9,
          "maximum": 24299.89
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=55.50 and M <64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1002",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21754.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21754.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21088.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21088.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22198.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21088.83,
          "maximum": 22198.77
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=47.50 and M <55.50- Tier None",
      "code_information": [
        {
          "code": "A1003",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23679.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23679.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22954.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22954.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24162.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22954.27,
          "maximum": 24162.39
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=47.50 and M <55.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1003",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 33815.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 33815.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 32780.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 32780.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34505.49,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32780.22,
          "maximum": 34505.49
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=47.50 and M <55.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1003",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28098.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28098.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27238.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27238.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28671.71,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27238.12,
          "maximum": 28671.71
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=47.50 and M <55.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1003",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25502.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25502.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24721.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24721.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26022.82,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24721.68,
          "maximum": 26022.82
        }
      ]
    },
    {
      "description": "Amputation lower extremity M <47.50- Tier None",
      "code_information": [
        {
          "code": "A1004",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 31497.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 31497.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 30533.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 30533.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32140.13,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30533.12,
          "maximum": 32140.13
        }
      ]
    },
    {
      "description": "Amputation lower extremity M <47.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1004",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 44979.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 44979.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 43602.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 43602.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 45897.27,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 43602.41,
          "maximum": 45897.27
        }
      ]
    },
    {
      "description": "Amputation lower extremity M <47.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1004",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 37374.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 37374.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 36230.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 36230.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 38137.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 36230.18,
          "maximum": 38137.03
        }
      ]
    },
    {
      "description": "Amputation lower extremity M <47.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1004",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 33921.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 33921.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 32883.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 32883.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34614.24,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32883.53,
          "maximum": 34614.24
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M >=58.50- Tier None",
      "code_information": [
        {
          "code": "A1101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18702.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18702.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18130.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18130.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19084.43,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18130.21,
          "maximum": 19084.43
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M >=58.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25738.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25738.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24950.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24950.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26263.63,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24950.45,
          "maximum": 26263.63
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M >=58.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24368.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24368.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23622.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23622.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24865.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23622.12,
          "maximum": 24865.39
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M >=58.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20970.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20970.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20328.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20328.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21398.92,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20328.97,
          "maximum": 21398.92
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M >=52.50 and M <58.50- Tier None",
      "code_information": [
        {
          "code": "A1102",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23776.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23776.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23048.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23048.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24261.59,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23048.51,
          "maximum": 24261.59
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M >=52.50 and M <58.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1102",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30188.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30188.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29264.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29264.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30804.38,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29264.16,
          "maximum": 30804.38
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M >=52.50 and M <58.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1102",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27826.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27826.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26974.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26974.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28394.01,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26974.31,
          "maximum": 28394.01
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M >=52.50 and M <58.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1102",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24266.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24266.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23523.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23523.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24761.49,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23523.42,
          "maximum": 24761.49
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M <52.50- Tier None",
      "code_information": [
        {
          "code": "A1103",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
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              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29649.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29649.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28741.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 28741.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30254.68,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28741.95,
          "maximum": 30254.68
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M <52.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1103",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 37645.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 37645.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 36493.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 36493.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 38414.02,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 36493.32,
          "maximum": 38414.02
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M <52.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1103",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35860.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35860.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34763.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34763.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36592.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34763.04,
          "maximum": 36592.67
        }
      ]
    },
    {
      "description": "Amputation non-lower extremity M <52.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1103",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30261.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30261.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29335.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29335.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30879.08,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29335.13,
          "maximum": 30879.08
        }
      ]
    },
    {
      "description": "Osteoarthritis M >=61.50- Tier None",
      "code_information": [
        {
          "code": "A1201",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16561.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16561.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 16054.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 16054.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16899.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16054.34,
          "maximum": 16899.3
        }
      ]
    },
    {
      "description": "Osteoarthritis M >=61.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1201",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25211.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25211.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24439.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24439.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25725.7,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24439.42,
          "maximum": 25725.7
        }
      ]
    },
    {
      "description": "Osteoarthritis M >=61.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1201",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20009.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20009.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19397.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19397.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20418.21,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19397.3,
          "maximum": 20418.21
        }
      ]
    },
    {
      "description": "Osteoarthritis M >=61.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1201",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17882.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17882.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17334.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17334.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18247.05,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17334.7,
          "maximum": 18247.05
        }
      ]
    },
    {
      "description": "Osteoarthritis M >=49.50 and M <61.50- Tier None",
      "code_information": [
        {
          "code": "A1202",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19661.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19661.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19060,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19060,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20063.16,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19060,
          "maximum": 20063.16
        }
      ]
    },
    {
      "description": "Osteoarthritis M >=49.50 and M <61.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1202",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30171.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30171.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29247.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29247.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30787.14,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29247.78,
          "maximum": 30787.14
        }
      ]
    },
    {
      "description": "Osteoarthritis M >=49.50 and M <61.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1202",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23526.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23526.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22806.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22806.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24007.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22806.68,
          "maximum": 24007.03
        }
      ]
    },
    {
      "description": "Osteoarthritis M >=49.50 and M <61.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1202",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21507.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21507.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20848.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20848.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21945.94,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20848.64,
          "maximum": 21945.94
        }
      ]
    },
    {
      "description": "Osteoarthritis M <49.50 and A >=74.50- Tier None",
      "code_information": [
        {
          "code": "A1203",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 26065.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26065.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25267.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25267.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26597.66,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25267.78,
          "maximum": 26597.66
        }
      ]
    },
    {
      "description": "Osteoarthritis M <49.50 and A >=74.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1203",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 39680.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 39680.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 38466.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 38466.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 40490.74,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 38466.2,
          "maximum": 40490.74
        }
      ]
    },
    {
      "description": "Osteoarthritis M <49.50 and A >=74.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1203",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 31493.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 31493.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 30529.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 30529.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 32136.25,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30529.44,
          "maximum": 32136.25
        }
      ]
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    {
      "description": "Osteoarthritis M <49.50 and A >=74.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1203",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 28143.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
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              "estimated_amount": 28143.95,
              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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              "estimated_amount": 28718.32,
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            },
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              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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            },
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              "payer_name": "Devoted Health",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 27282.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 27282.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 28718.32,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27282.4,
          "maximum": 28718.32
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      ]
    },
    {
      "description": "Osteoarthritis M <49.50 and A <74.50- Tier None",
      "code_information": [
        {
          "code": "A1204",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 27382.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 27382.23,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 27382.23,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 27382.23,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 27382.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 26834.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26834.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 27382.23,
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            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 27382.23,
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            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 27382.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 27382.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 27382.23,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 26013.12,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 26013.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 27382.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 27382.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 27382.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 27382.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 27382.23,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26013.12,
          "maximum": 27382.23
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      ]
    },
    {
      "description": "Osteoarthritis M <49.50 and A <74.50- Tier Tier 1",
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        {
          "code": "B1204",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 40988.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 40988.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 39733.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 39733.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41825.23,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39733.97,
          "maximum": 41825.23
        }
      ]
    },
    {
      "description": "Osteoarthritis M <49.50 and A <74.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1204",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 32424.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32424.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 31431.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 31431.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33085.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31431.59,
          "maximum": 33085.88
        }
      ]
    },
    {
      "description": "Osteoarthritis M <49.50 and A <74.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1204",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29217.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29217.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28323.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 28323.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 29814.15,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28323.44,
          "maximum": 29814.15
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=62.50- Tier None",
      "code_information": [
        {
          "code": "A1301",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16433.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16433.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15930.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15930.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16768.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15930.24,
          "maximum": 16768.67
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=62.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1301",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24637.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24637.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23883.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23883.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 25140.23,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23883.22,
          "maximum": 25140.23
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=62.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1301",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19774.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19774.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19169.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19169.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20178.29,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19169.38,
          "maximum": 20178.29
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=62.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1301",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17755.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17755.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17212.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17212.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18118.28,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17212.37,
          "maximum": 18118.28
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=51.50 and M <62.50- Tier None",
      "code_information": [
        {
          "code": "A1302",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20542.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20542.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19913.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19913.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20961.46,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19913.39,
          "maximum": 20961.46
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=51.50 and M <62.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1302",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29407.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29407.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28506.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 28506.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30007.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28506.84,
          "maximum": 30007.2
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=51.50 and M <62.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1302",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23604.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23604.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22882.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22882.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24086.48,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22882.16,
          "maximum": 24086.48
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=51.50 and M <62.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1302",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22083.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22083.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21407.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21407.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22533.95,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21407.25,
          "maximum": 22533.95
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50- Tier None",
      "code_information": [
        {
          "code": "A1303",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23370.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23370.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22655.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22655.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
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            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23847.87,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22655.48,
          "maximum": 23847.87
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      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1303",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 33784.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 33784.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 34474.42,
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            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 32750.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 32750.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 34474.42,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32750.7,
          "maximum": 34474.42
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1303",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27009.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27009.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 26182.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 26182.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 27560.89,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26182.85,
          "maximum": 27560.89
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1303",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 25122.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25122.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 24353.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24353.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25634.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24353.14,
          "maximum": 25634.88
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M <44.50 and A >=64.50- Tier None",
      "code_information": [
        {
          "code": "A1304",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29514.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29514.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 28610.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 28610.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30116.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28610.93,
          "maximum": 30116.77
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M <44.50 and A >=64.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1304",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 43605.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 43605.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 42270.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
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              "estimated_amount": 42270.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
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              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
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              "estimated_amount": 44495.14,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42270.38,
          "maximum": 44495.14
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M <44.50 and A >=64.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1304",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
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              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 34862.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 34862.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 33794.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 33794.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35573.59,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33794.91,
          "maximum": 35573.59
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M <44.50 and A >=64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1304",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
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              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
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              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "standard_charge_percentage": 98,
              "estimated_amount": 31942.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 31942.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 32594.56,
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            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
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              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 30964.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 30964.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32594.56,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30964.83,
          "maximum": 32594.56
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M <51.50 and A <64.50- Tier None",
      "code_information": [
        {
          "code": "A1305",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28958.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28958.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28072.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 28072.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 29549.5,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28072.03,
          "maximum": 29549.5
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M <51.50 and A <64.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1305",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
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            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 43519.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 43519.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
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              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 42187.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 42187.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 44407.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42187.36,
          "maximum": 44407.75
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M <51.50 and A <64.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1305",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 34791.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 34791.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 33726.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 33726.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35501.73,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33726.64,
          "maximum": 35501.73
        }
      ]
    },
    {
      "description": "Rheumatoid other arthritis M <51.50 and A <64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1305",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 31877.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 31877.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 30902.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 30902.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32528.53,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30902.1,
          "maximum": 32528.53
        }
      ]
    },
    {
      "description": "Cardiac M >=68.50- Tier None",
      "code_information": [
        {
          "code": "A1401",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 14566.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 14566.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 14120.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 14120.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 14864.08,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 14120.88,
          "maximum": 14864.08
        }
      ]
    },
    {
      "description": "Cardiac M >=68.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1401",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21267.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21267.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20616.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20616.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21701.87,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20616.78,
          "maximum": 21701.87
        }
      ]
    },
    {
      "description": "Cardiac M >=68.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1401",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17132.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17132.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 16607.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 16607.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17481.9,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16607.81,
          "maximum": 17481.9
        }
      ]
    },
    {
      "description": "Cardiac M >=68.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1401",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 15840.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 15840.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15355.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15355.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16163.28,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15355.12,
          "maximum": 16163.28
        }
      ]
    },
    {
      "description": "Cardiac M >=55.50 and M <68.50- Tier None",
      "code_information": [
        {
          "code": "A1402",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18557.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18557.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17989.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17989.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18936.46,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17989.64,
          "maximum": 18936.46
        }
      ]
    },
    {
      "description": "Cardiac M >=55.50 and M <68.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1402",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27093.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27093.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26264.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26264.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27646.34,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26264.02,
          "maximum": 27646.34
        }
      ]
    },
    {
      "description": "Cardiac M >=55.50 and M <68.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1402",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21825.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21825.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21157.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21157.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22270.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21157.34,
          "maximum": 22270.88
        }
      ]
    },
    {
      "description": "Cardiac M >=55.50 and M <68.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1402",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20179.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20179.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19561.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19561.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20591.04,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19561.49,
          "maximum": 20591.04
        }
      ]
    },
    {
      "description": "Cardiac M >=45.50 and M <55.50- Tier None",
      "code_information": [
        {
          "code": "A1403",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22430.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22430.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21744.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21744.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22888.43,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21744.01,
          "maximum": 22888.43
        }
      ]
    },
    {
      "description": "Cardiac M >=45.50 and M <55.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1403",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32870.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32870.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31864.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31864.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33541.4,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31864.33,
          "maximum": 33541.4
        }
      ]
    },
    {
      "description": "Cardiac M >=45.50 and M <55.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1403",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26379.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26379.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25572.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25572.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26918.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25572.19,
          "maximum": 26918.09
        }
      ]
    },
    {
      "description": "Cardiac M >=45.50 and M <55.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1403",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24390.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24390.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23644.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23644.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24888.69,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23644.26,
          "maximum": 24888.69
        }
      ]
    },
    {
      "description": "Cardiac M <45.50- Tier None",
      "code_information": [
        {
          "code": "A1404",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27986,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27986,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27129.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27129.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28557.14,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27129.28,
          "maximum": 28557.14
        }
      ]
    },
    {
      "description": "Cardiac M <45.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1404",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 40857.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 40857.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 39606.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 39606.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 41690.89,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39606.35,
          "maximum": 41690.89
        }
      ]
    },
    {
      "description": "Cardiac M <45.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1404",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32913.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32913.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31905.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31905.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33584.98,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31905.73,
          "maximum": 33584.98
        }
      ]
    },
    {
      "description": "Cardiac M <45.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1404",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30433.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30433.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29501.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29501.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31054.55,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29501.82,
          "maximum": 31054.55
        }
      ]
    },
    {
      "description": "Pulmonary M >=68.50- Tier None",
      "code_information": [
        {
          "code": "A1501",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17950.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17950.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17401.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17401.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18316.96,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17401.11,
          "maximum": 18316.96
        }
      ]
    },
    {
      "description": "Pulmonary M >=68.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1501",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24937.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24937.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24173.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24173.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25446.05,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24173.75,
          "maximum": 25446.05
        }
      ]
    },
    {
      "description": "Pulmonary M >=68.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1501",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20051.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20051.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19437.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19437.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20460.93,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19437.88,
          "maximum": 20460.93
        }
      ]
    },
    {
      "description": "Pulmonary M >=68.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1501",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18778.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18778.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18203.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18203.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19161.73,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18203.64,
          "maximum": 19161.73
        }
      ]
    },
    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier None",
      "code_information": [
        {
          "code": "A1502",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21951.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21951.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21279.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21279.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22399.05,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21279.1,
          "maximum": 22399.05
        }
      ]
    },
    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1502",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30492.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30492.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29559.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29559.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31114.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29559.01,
          "maximum": 31114.75
        }
      ]
    },
    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1502",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24619.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24619.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23865.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23865.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25121.57,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23865.49,
          "maximum": 25121.57
        }
      ]
    },
    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1502",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23153.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23153.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22444.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22444.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23625.69,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22444.41,
          "maximum": 23625.69
        }
      ]
    },
    {
      "description": "Pulmonary M >=45.50 and M <56.50- Tier None",
      "code_information": [
        {
          "code": "A1503",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25589.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25589.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24806.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24806.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26112.16,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24806.55,
          "maximum": 26112.16
        }
      ]
    },
    {
      "description": "Pulmonary M >=45.50 and M <56.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1503",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35551.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35551.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34462.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34462.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36276.59,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34462.76,
          "maximum": 36276.59
        }
      ]
    },
    {
      "description": "Pulmonary M >=45.50 and M <56.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1503",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28585.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28585.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27710.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27710.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 29168.87,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27710.43,
          "maximum": 29168.87
        }
      ]
    },
    {
      "description": "Pulmonary M >=45.50 and M <56.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1503",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26769.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26769.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25950.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25950.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27316.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25950.39,
          "maximum": 27316.2
        }
      ]
    },
    {
      "description": "Pulmonary M <45.50- Tier None",
      "code_information": [
        {
          "code": "A1504",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32091.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32091.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31108.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31108.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32746.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31108.73,
          "maximum": 32746.03
        }
      ]
    },
    {
      "description": "Pulmonary M <45.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1504",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 44581.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 44581.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 43216.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 43216.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 45491.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 43216.82,
          "maximum": 45491.39
        }
      ]
    },
    {
      "description": "Pulmonary M <45.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1504",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35846.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35846.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34748.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34748.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36577.6,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34748.72,
          "maximum": 36577.6
        }
      ]
    },
    {
      "description": "Pulmonary M <45.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1504",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 33569.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 33569.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 32542.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 32542.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34254.97,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32542.22,
          "maximum": 34254.97
        }
      ]
    },
    {
      "description": "Pain syndrome M >=65.50- Tier None",
      "code_information": [
        {
          "code": "A1601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 15273.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 15273.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 14805.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 14805.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 15585.1,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 14805.85,
          "maximum": 15585.1
        }
      ]
    },
    {
      "description": "Pain syndrome M >=65.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24574.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24574.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23821.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23821.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25075.6,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23821.82,
          "maximum": 25075.6
        }
      ]
    },
    {
      "description": "Pain syndrome M >=65.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18254.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18254.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17695.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17695.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18626.66,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17695.33,
          "maximum": 18626.66
        }
      ]
    },
    {
      "description": "Pain syndrome M >=65.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16499.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16499.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15994.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15994.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16835.82,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15994.03,
          "maximum": 16835.82
        }
      ]
    },
    {
      "description": "Pain syndrome M >=58.50 and M <65.50- Tier None",
      "code_information": [
        {
          "code": "A1602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18208.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18208.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17651.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17651.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18580.32,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17651.3,
          "maximum": 18580.32
        }
      ]
    },
    {
      "description": "Pain syndrome M >=58.50 and M <65.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28161.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28161.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27299.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27299.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28735.81,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27299.02,
          "maximum": 28735.81
        }
      ]
    },
    {
      "description": "Pain syndrome M >=58.50 and M <65.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21572.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21572.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20911.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20911.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22012.59,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20911.96,
          "maximum": 22012.59
        }
      ]
    },
    {
      "description": "Pain syndrome M >=58.50 and M <65.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19810.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19810.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19204.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19204.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20214.82,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19204.08,
          "maximum": 20214.82
        }
      ]
    },
    {
      "description": "Pain syndrome M >=43.50 and M <58.50- Tier None",
      "code_information": [
        {
          "code": "A1603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22102.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22102.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21425.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21425.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22553.1,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21425.45,
          "maximum": 22553.1
        }
      ]
    },
    {
      "description": "Pain syndrome M >=43.50 and M <58.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35564.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35564.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34475.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34475.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36289.91,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34475.41,
          "maximum": 36289.91
        }
      ]
    },
    {
      "description": "Pain syndrome M >=43.50 and M <58.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
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              "estimated_amount": 26415.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26415.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25606.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25606.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26954.55,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25606.82,
          "maximum": 26954.55
        }
      ]
    },
    {
      "description": "Pain syndrome M >=43.50 and M <58.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1603",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 23898.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 23898.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
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              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23166.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23166.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
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              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24385.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23166.43,
          "maximum": 24385.72
        }
      ]
    },
    {
      "description": "Pain syndrome M <43.50- Tier None",
      "code_information": [
        {
          "code": "A1604",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
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              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28353.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28353.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27485.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 95,
              "estimated_amount": 27485.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28931.94,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27485.34,
          "maximum": 28931.94
        }
      ]
    },
    {
      "description": "Pain syndrome M <43.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1604",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 44063.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 44063.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 42714.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 42714.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 44962.56,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42714.43,
          "maximum": 44962.56
        }
      ]
    },
    {
      "description": "Pain syndrome M <43.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1604",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 34196.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 34196.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 33149.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 33149.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34893.89,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33149.2,
          "maximum": 34893.89
        }
      ]
    },
    {
      "description": "Pain syndrome M <43.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1604",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 31280.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 31280.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 30322.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 30322.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31918.74,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30322.8,
          "maximum": 31918.74
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=57.50- Tier None",
      "code_information": [
        {
          "code": "A1701",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16999.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16999.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 16478.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 16478.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17345.96,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16478.66,
          "maximum": 17345.96
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=57.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1701",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25104.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25104.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24336.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24336.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25616.95,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24336.1,
          "maximum": 25616.95
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=57.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1701",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19888.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19888.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19279.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19279.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20293.92,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19279.22,
          "maximum": 20293.92
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=57.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1701",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18464.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18464.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17899.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17899.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18841.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17899.24,
          "maximum": 18841.3
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50- Tier None",
      "code_information": [
        {
          "code": "A1702",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20953.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20953.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20312.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20312.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21381.44,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20312.37,
          "maximum": 21381.44
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1702",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 31181.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 31181.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 30226.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 30226.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31817.59,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30226.71,
          "maximum": 31817.59
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1702",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24514.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24514.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23764.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23764.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25014.93,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23764.18,
          "maximum": 25014.93
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1702",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22761.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22761.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 22065.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 22065.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23226.34,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22065.02,
          "maximum": 23226.34
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50- Tier None",
      "code_information": [
        {
          "code": "A1703",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24586.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24586.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23834.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23834.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25088.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23834.28,
          "maximum": 25088.72
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1703",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 37052.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 37052.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 35918.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 35918.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 37808.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35918.33,
          "maximum": 37808.77
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1703",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28801.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28801.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27919.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27919.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 29388.94,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27919.49,
          "maximum": 29388.94
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1703",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 26707.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 26707.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25889.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25889.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27252.11,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25889.5,
          "maximum": 27252.11
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50- Tier None",
      "code_information": [
        {
          "code": "A1704",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 28292.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 28292.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 27426.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 27426.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28869.8,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27426.31,
          "maximum": 28869.8
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1704",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 41938.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 41938.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 40654.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 40654.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 42794.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 40654.67,
          "maximum": 42794.39
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1704",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 33099.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 33099.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 32086.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 32086.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33775.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32086.54,
          "maximum": 33775.3
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1704",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 30732.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 30732.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 29791.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 29791.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31359.44,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29791.47,
          "maximum": 31359.44
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M <36.50- Tier None",
      "code_information": [
        {
          "code": "A1705",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32936.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32936.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31927.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31927.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33608.28,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31927.87,
          "maximum": 33608.28
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M <36.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1705",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 49215.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 49215.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 47709.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 47709.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 50220.16,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 47709.15,
          "maximum": 50220.16
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M <36.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1705",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 38533.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 38533.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 37353.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 37353.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39319.71,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 37353.72,
          "maximum": 39319.71
        }
      ]
    },
    {
      "description": "Major multiple trauma without brain or spinal cord injury M <36.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1705",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35777.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35777.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34682.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34682.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36507.69,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34682.31,
          "maximum": 36507.69
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=67.50- Tier None",
      "code_information": [
        {
          "code": "A1801",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 15042.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 15042.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 14582.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 14582.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 15349.58,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 14582.1,
          "maximum": 15349.58
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=67.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1801",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 21294.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 21294.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 20642.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 20642.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21729.06,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20642.61,
          "maximum": 21729.06
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=67.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1801",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 17421.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 17421.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 16888.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 16888.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17777.08,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16888.23,
          "maximum": 17777.08
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=67.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1801",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 16026.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 16026.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15535.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15535.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16353.6,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15535.92,
          "maximum": 16353.6
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50- Tier None",
      "code_information": [
        {
          "code": "A1802",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 19121.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 19121.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 18535.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 18535.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19511.29,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18535.73,
          "maximum": 19511.29
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1802",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27068.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27068.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26240.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26240.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27621.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26240.04,
          "maximum": 27621.09
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1802",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 22145.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 22145.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 21467.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 21467.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22597.13,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21467.27,
          "maximum": 22597.13
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1802",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 20371.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 20371.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 19747.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 19747.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20787.19,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19747.83,
          "maximum": 20787.19
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50- Tier None",
      "code_information": [
        {
          "code": "A1803",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 24089.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 24089.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 23352.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 23352.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24581.45,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23352.38,
          "maximum": 24581.45
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1803",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 34304.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 34304.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 33254.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 33254.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35004.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33254.48,
          "maximum": 35004.72
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1803",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27548.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27548.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26704.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26704.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28110.48,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26704.96,
          "maximum": 28110.48
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1803",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25981.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25981.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 25186.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 25186.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26512.11,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25186.5,
          "maximum": 26512.11
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50- Tier None",
      "code_information": [
        {
          "code": "A1804",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 27780.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 27780.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 26930.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 26930.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28347.4,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26930.03,
          "maximum": 28347.4
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1804",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 39328.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 39328.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 38124.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 38124.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 40131.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 38124.9,
          "maximum": 40131.47
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1804",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 32174.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 32174.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 31189.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 31189.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32831.48,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31189.91,
          "maximum": 32831.48
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1804",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29597.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 29597.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 28691.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 28691.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30202.01,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28691.91,
          "maximum": 30202.01
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50- Tier None",
      "code_information": [
        {
          "code": "A1805",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 33328.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 33328.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 32307.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 32307.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34008.34,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32307.92,
          "maximum": 34008.34
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1805",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 47183.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 47183.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 45738.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 45738.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 48146.11,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 45738.8,
          "maximum": 48146.11
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1805",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 38599.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 38599.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 37418.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 37418.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
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              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39387.68,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 37418.3,
          "maximum": 39387.68
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1805",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 35509.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 35509.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 34422.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 34422.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36233.87,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34422.18,
          "maximum": 36233.87
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M <30.50- Tier None",
      "code_information": [
        {
          "code": "A1806",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 48287.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 48287.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 46808.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 46808.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 49272.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 46808.85,
          "maximum": 49272.47
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M <30.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1806",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 68359.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 68359.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 66267.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 66267.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 69754.76,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 66267.02,
          "maximum": 69754.76
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M <30.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1806",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 55924.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 55924.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 54212.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 54212.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 57065.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 54212.43,
          "maximum": 57065.72
        }
      ]
    },
    {
      "description": "Major multiple trauma with brain or spinal cord injury M <30.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1806",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 51446.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 51446.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 49871.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 49871.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 52496.19,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 49871.38,
          "maximum": 52496.19
        }
      ]
    },
    {
      "description": "Guillain-Barré M >=66.50- Tier None",
      "code_information": [
        {
          "code": "A1901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 15682.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 15682.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15201.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15201.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16002.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15201.99,
          "maximum": 16002.09
        }
      ]
    },
    {
      "description": "Guillain-Barré M >=66.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 25515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 25515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 24734.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 24734.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26036.42,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24734.6,
          "maximum": 26036.42
        }
      ]
    },
    {
      "description": "Guillain-Barré M >=66.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 18032.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 18032.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 17480.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 17480.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "HealthSpring Life & Health Insurance Company aka Cigna HealthSpring",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Molina Medicare Options Plus",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Texas Independence Health Plan (TIHP)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18400.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17480.45,
          "maximum": 18400.47
        }
      ]
    },
    {
      "description": "Guillain-Barré M >=66.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Commercial EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Coventry Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "Medicare Advantage Plan (MA Plan)",
              "standard_charge_percentage": 98,
              "estimated_amount": 15676.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Superior HealthPlan",
              "plan_name": "MA-PD Plan",
              "standard_charge_percentage": 98,
              "estimated_amount": 15676.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Star+PLUS Medicare-Medicaid Program",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Molina Healthcare of Texas",
              "plan_name": "Health Insurance Marketplace (ACA)",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 95,
              "estimated_amount": 15196.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 95,
              "estimated_amount": 15196.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellPoint fka AmeriGroup Texas",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 15996.27,